NPIMap

Organization Active NPI

Minerva Labs LLC

  • Clinical Medical Laboratory
  • Southlake, TX
National Provider Identifier
1053112938
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MINERVA LABS LLC
Practice address
1203 S White Chapel Blvd Ste 150
Southlake, TX 76092-9374
Phone
(817) 333-9898
NPI assigned
Mar 24, 2025
Last updated
Mar 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Nicholas Wiles
Title
Owner
Phone
(817) 333-9898

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

1203 S White Chapel Blvd Ste 150
Southlake, TX 76092-9374

Mailing address

1203 S White Chapel Blvd Ste 150
Southlake, TX 76092-9374

National Provider Directory

National Provider Directory

Locations

1203 S White Chapel Blvd
Ste 150
Southlake, TX 76092
Phone (817) 333-9898

Practitioners & affiliated clinicians

Practitioners 46

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 46

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1742774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742860800000",
    "number": "1053112938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 S WHITE CHAPEL BLVD STE 150",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760929374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 S WHITE CHAPEL BLVD STE 150",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760929374",
            "telephone_number": "817-333-9898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINERVA LABS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-24",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A",
        "authorized_official_last_name": "WILES",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-333-9898",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.