Provider Demographics
NPI:1386871101
Name:THUNDER BAY COMMUNITY HEALTH SERVICE, INC.
Entity type:Organization
Organization Name:THUNDER BAY COMMUNITY HEALTH SERVICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WINEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-785-5535
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:ONAWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49765-0722
Mailing Address - Country:US
Mailing Address - Phone:989-733-7037
Mailing Address - Fax:989-733-7069
Practice Address - Street 1:21258 M 68 HWY
Practice Address - Street 2:
Practice Address - City:ONAWAY
Practice Address - State:MI
Practice Address - Zip Code:49765-9692
Practice Address - Country:US
Practice Address - Phone:989-733-7037
Practice Address - Fax:989-733-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010091083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120186OtherPK