Provider Demographics
NPI:1265544407
Name:NUVO DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:NUVO DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MT, CHT
Authorized Official - Phone:214-828-4702
Mailing Address - Street 1:2909 LEMMON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2311
Mailing Address - Country:US
Mailing Address - Phone:214-828-4702
Mailing Address - Fax:214-370-5130
Practice Address - Street 1:3409 OAK GROVE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2332
Practice Address - Country:US
Practice Address - Phone:214-828-4702
Practice Address - Fax:214-370-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory