New Wave Clinical Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

NEW WAVE CLINICAL LABORATORY LLC

Practice address

4980 N State Road 7
Tamarac, FL 33319-5810

Phone

(954) 751-5100

Fax

(954) 751-5200

NPI assigned

Aug 29, 2022

Organization subpart

No

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

Authorized official

Name

Greg Roman

Title

Owner

Phone

(954) 751-5100

Specialties & licenses 1

Addresses

Other names 1

• Quality Laboratory Services Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679875200000",
    "number": "1609596907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4980 N STATE ROAD 7",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333195810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4980 N STATE ROAD 7",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333195810",
            "telephone_number": "954-751-5100",
            "fax_number": "954-751-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW WAVE CLINICAL LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-29",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A",
        "authorized_official_last_name": "ROMAN",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-751-5100"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quality Laboratory Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Tamarac, FL
• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.