MEDICARE: TRUE NORTH III DC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1740005388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE NORTH III DC LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L AND C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 GRAND BLVD
Second Line	:
City	:	DEER PARK
State	:	NY
Zip	:	11729-5706
Country	:	US
Telephone Number	:	631-243-7770
Fax Number	:	631-243-7775

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	SAMUEL WEY
Credential	:
Telephone Number	:	615-320-4414

Provider Enumeration Date	:	11/19/2024
Last Update Date	:	11/19/2024

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