MEDICARE: NUWAV LABS

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1811732324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUWAV LABS

Provider Business Mailing Address
First Line	:	2015 MIDWAY RD STE 111
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-5181
Country	:	US
Telephone Number	:	972-327-8857
Fax Number	:	972-327-8862

Provider Business Practice Location Address
First Line	:	2015 MIDWAY RD STE 111
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-5181
Country	:	US
Telephone Number	:	269-598-1372
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	VINCENT THAYER
Credential	:
Telephone Number	:	972-327-8857

Provider Enumeration Date	:	06/26/2024
Last Update Date	:	01/17/2026

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