| Thunder Bay Community Health Service, Inc | |
|
15774 State Street Hillman MI 49746 | |
| (989) 742-4583 | |
| (989) 742-4298 |
| Full Name | Thunder Bay Community Health Service, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 15774 State Street, Hillman, Michigan |
| Authorized Official Name and Position | Richard Bates (INTERIM CEO) |
| Authorized Official Contact | 9897424583 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thunder Bay Community Health Service, Inc Po Box 427 Hillman MI 49746-0427 Ph: (989) 742-4583 | Thunder Bay Community Health Service, Inc 15774 State Street Hillman MI 49746 Ph: (989) 742-4583 |
| NPI Number | 1629107552 |
|---|---|
| Provider Enumeration Date | 03/05/2007 |
| Last Update Date | 03/13/2023 |
| Medicare PECOS PAC ID | 0143296772 |
|---|---|
| Medicare Enrollment ID | O20040907000045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629107552 | NPI | - | NPPES |
| 0F06016 | Other | MI | MEDICARE BILL PAY TO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Jonathan G A Henry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164470068 PECOS PAC ID: 4385543909 Enrollment ID: I20040102000575 |
| Provider Name | Cheryl L Henry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730197278 PECOS PAC ID: 2567403082 Enrollment ID: I20050516000272 |
| Provider Name | Monika Arora |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083705727 PECOS PAC ID: 7618911124 Enrollment ID: I20050615000872 |
| Provider Name | David R Hunter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447276167 PECOS PAC ID: 6709888589 Enrollment ID: I20070207000370 |
| Provider Name | Susan Lynn Allred |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396874988 PECOS PAC ID: 3577668979 Enrollment ID: I20070413000077 |
| Provider Name | Veronica A Jung |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497982607 PECOS PAC ID: 4385797968 Enrollment ID: I20090729000548 |
| Provider Name | Bonnie R Bartz |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1720192883 PECOS PAC ID: 9739260423 Enrollment ID: I20090825000448 |
| Provider Name | Julie A Gilbert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083845937 PECOS PAC ID: 6406992759 Enrollment ID: I20090930000315 |
| Provider Name | Jemelle P Jacala-tadian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669681748 PECOS PAC ID: 6204977580 Enrollment ID: I20100108000350 |
| Provider Name | Carrie A Standen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568795177 PECOS PAC ID: 9335281658 Enrollment ID: I20100126000149 |
| Provider Name | Walter W Jacquemin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1447259783 PECOS PAC ID: 4789579038 Enrollment ID: I20100610000511 |
| Provider Name | Marion C Hautea |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1962455972 PECOS PAC ID: 4082739263 Enrollment ID: I20100910000741 |
| Provider Name | Leah H Arnold |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609004951 PECOS PAC ID: 5991998460 Enrollment ID: I20101018000722 |
| Provider Name | Laura L Kauffman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346380102 PECOS PAC ID: 0749463883 Enrollment ID: I20110325000865 |
| Provider Name | Larry F Lacross |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245475417 PECOS PAC ID: 3678742665 Enrollment ID: I20110809000157 |
| Provider Name | Amy M Brewbaker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326473976 PECOS PAC ID: 7618106410 Enrollment ID: I20140127000401 |
| Provider Name | Kim J Sumerix |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871892737 PECOS PAC ID: 5395974992 Enrollment ID: I20140130001627 |
| Provider Name | Nina N Niemetta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376967612 PECOS PAC ID: 1153646823 Enrollment ID: I20150223000170 |
| Provider Name | Cori A Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710371877 PECOS PAC ID: 4880914738 Enrollment ID: I20150518001184 |
| Provider Name | Cathy L Obrien |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639592355 PECOS PAC ID: 0143533885 Enrollment ID: I20150723008354 |
| Provider Name | Lindsey N Grace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518330257 PECOS PAC ID: 1153622493 Enrollment ID: I20151210002396 |
| Provider Name | Lindsay A Humphrey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679949135 PECOS PAC ID: 5698076495 Enrollment ID: I20151221002091 |
| Provider Name | Holly K Ehrke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174079636 PECOS PAC ID: 7618263997 Enrollment ID: I20160913001562 |
| Provider Name | Melanie L Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508315409 PECOS PAC ID: 7719268135 Enrollment ID: I20161227000102 |
| Provider Name | Jessie Lalonde |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1710355490 PECOS PAC ID: 1254616212 Enrollment ID: I20170315000195 |
| Provider Name | Manuel J Hernandez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851705602 PECOS PAC ID: 9032488358 Enrollment ID: I20170629002512 |
| Provider Name | Amy J Code |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689192809 PECOS PAC ID: 1153696216 Enrollment ID: I20170929001492 |
| Provider Name | Anna E Krueger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689199804 PECOS PAC ID: 0648536862 Enrollment ID: I20171103001685 |
| Provider Name | Caitlin Elizabeth Sulfridge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194196261 PECOS PAC ID: 7719246248 Enrollment ID: I20180109000906 |
| Provider Name | Allan D Hoffmeyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952538126 PECOS PAC ID: 7214296698 Enrollment ID: I20180110000354 |
| Provider Name | Teri Grody |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063926277 PECOS PAC ID: 7012276843 Enrollment ID: I20180124000187 |
| Provider Name | Keisha R Carroll |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891167581 PECOS PAC ID: 9032455696 Enrollment ID: I20190118000538 |
| Provider Name | Laurie Alane Mousseau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497292320 PECOS PAC ID: 6103167416 Enrollment ID: I20190416000233 |
| Provider Name | Mary B Jameson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992106702 PECOS PAC ID: 9739414228 Enrollment ID: I20190703002210 |
| Provider Name | Katie Ann Morell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558929414 PECOS PAC ID: 2769711985 Enrollment ID: I20190912001262 |
| Provider Name | Nickole L Stein-fisher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275094617 PECOS PAC ID: 5395175673 Enrollment ID: I20200429001298 |
| Provider Name | Meagan E Florip |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780249318 PECOS PAC ID: 4688090426 Enrollment ID: I20200811003349 |
| Provider Name | Sean T Kane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659987014 PECOS PAC ID: 6305266461 Enrollment ID: I20201012002436 |
| Provider Name | Kayla M Durocher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700350774 PECOS PAC ID: 0547673717 Enrollment ID: I20210107000208 |
| Provider Name | Muhammad Abdelhai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083190888 PECOS PAC ID: 4981935921 Enrollment ID: I20210720000822 |
| Provider Name | Osama Md Ahmed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578049326 PECOS PAC ID: 5890198196 Enrollment ID: I20210723002621 |
| Provider Name | Nikkie J Lalonde-viegelahn |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1427629435 PECOS PAC ID: 6204231608 Enrollment ID: I20210824000582 |
| Provider Name | Anna R Nadolsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801566377 PECOS PAC ID: 1850789587 Enrollment ID: I20211028001607 |
| Provider Name | Rebecca L Kalbfleisch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871259051 PECOS PAC ID: 9335531979 Enrollment ID: I20220112000196 |
| Provider Name | Stephany R Peffers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316587496 PECOS PAC ID: 1658764626 Enrollment ID: I20220215002578 |
| Provider Name | Jensen L Vanpamel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477177780 PECOS PAC ID: 6709269921 Enrollment ID: I20220819001465 |
| Provider Name | Barbara M Hoose |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1285730085 PECOS PAC ID: 9537166418 Enrollment ID: I20221028001753 |
| Provider Name | Lacy Bates |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194277012 PECOS PAC ID: 2466820089 Enrollment ID: I20221201001093 |
| Provider Name | Connie M Booms |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700591005 PECOS PAC ID: 9032581509 Enrollment ID: I20230209000970 |
| Provider Name | Amber Kalitta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700498094 PECOS PAC ID: 2769854231 Enrollment ID: I20230209000975 |
| Provider Name | Amy Nowak |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1487306429 PECOS PAC ID: 9436517984 Enrollment ID: I20230615002239 |
| Provider Name | Elizabeth J Morley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285223453 PECOS PAC ID: 6901252824 Enrollment ID: I20231030002322 |
| Provider Name | Dana La Bar |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992356083 PECOS PAC ID: 1456704980 Enrollment ID: I20240131001987 |
| Provider Name | Kristine Goodroe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245621853 PECOS PAC ID: 4183068968 Enrollment ID: I20240220003411 |
| Provider Name | Brenda Easterling |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649544073 PECOS PAC ID: 3779928163 Enrollment ID: I20240226000545 |
| Provider Name | Laura Rea |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578986022 PECOS PAC ID: 0143665398 Enrollment ID: I20240228001157 |
| Provider Name | Susan Whitener |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912412164 PECOS PAC ID: 9739526484 Enrollment ID: I20240318002340 |
| Provider Name | Bridget M Goss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851011548 PECOS PAC ID: 7416395710 Enrollment ID: I20240405001173 |
Thunder Bay Community Health Service, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 245 E Third St, Hillman, MI 49746 Phone: 989-742-4537 Fax: 989-742-4298 | |
Thunder Bay Community Health Service, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 631 Caring Street, Hillman, MI 49746 Phone: 989-354-2197 Fax: 989-356-6524 | |
Thunder Bay Community Health Service, Inc Mobile Unit 1 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 15774 State St, Hillman, MI 49746 Phone: 989-742-4583 Fax: 989-742-2183 | |
Thunder Bay Community Health Service, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 15774 Sate Street, Hillman, MI 49746 Phone: 989-742-4583 Fax: 989-742-4298 |