Provider Demographics
NPI:1265205066
Name:TRUENORTH360 MEDICAL LLC
Entity type:Organization
Organization Name:TRUENORTH360 MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:720-201-0708
Mailing Address - Street 1:93 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-3117
Mailing Address - Country:US
Mailing Address - Phone:720-201-0708
Mailing Address - Fax:888-862-4414
Practice Address - Street 1:93 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-3117
Practice Address - Country:US
Practice Address - Phone:720-201-0708
Practice Address - Fax:888-862-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty