Provider Demographics
NPI:1205604766
Name:TRUE NORTH MEDICAL LLC
Entity type:Organization
Organization Name:TRUE NORTH MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HANQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:402-366-0872
Mailing Address - Street 1:12845 B RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS
Mailing Address - State:NE
Mailing Address - Zip Code:68628-5213
Mailing Address - Country:US
Mailing Address - Phone:402-366-0872
Mailing Address - Fax:
Practice Address - Street 1:212 N GREEN ST
Practice Address - Street 2:
Practice Address - City:CLARKS
Practice Address - State:NE
Practice Address - Zip Code:68628-2759
Practice Address - Country:US
Practice Address - Phone:402-366-0872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care