MEDICARE: WAVE FORMS MED TECH, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1578416277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAVE FORMS MED TECH, LLC

Provider Business Mailing Address
First Line	:	7455 FRANCE AVE S STE 363
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-4702
Country	:	US
Telephone Number	:	855-712-9147
Fax Number	:	800-503-5976

Provider Business Practice Location Address
First Line	:	7455 FRANCE AVE S STE 363
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-4702
Country	:	US
Telephone Number	:	855-712-9147
Fax Number	:	800-503-5976

Authorized Official
Title or Position	:	CEO
Name	:	NICK SC
Credential	:
Telephone Number	:	612-991-3343

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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Directions to “WAVE FORMS MED TECH, LLC ” Practice Location

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