Provider Demographics
NPI:1780676684
Name:THIRLBY CLINIC PLC
Entity type:Organization
Organization Name:THIRLBY CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHICHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-8929
Mailing Address - Street 1:4110 COPPER RIDGE DRIVE
Mailing Address - Street 2:STE 100
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:231-935-8950
Mailing Address - Fax:231-935-8868
Practice Address - Street 1:4110 COPPER RIDGE DRIVE
Practice Address - Street 2:STE 100
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-935-8950
Practice Address - Fax:231-935-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B86026Medicare ID - Type Unspecified
MI0B86020Medicare ID - Type Unspecified