Healthcare Provider Details

I. General information

NPI: 1144190422
Provider Name (Legal Business Name): WOUND100 MEDICAL ALABAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 EAGLE POINT CORPORATE DR
BIRMINGHAM AL
35242-1900
US

IV. Provider business mailing address

19681 CHICAGO ST APT A
ELKHORN NE
68022-6525
US

V. Phone/Fax

Practice location:
  • Phone: 402-651-6040
  • Fax:
Mailing address:
  • Phone: 402-651-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LEAH FORD
Title or Position: CHIEF MEDICAL OFFICER
Credential: DPM
Phone: 561-400-5303