Healthcare Provider Details

I. General information

NPI: 1407727993
Provider Name (Legal Business Name): WOUND100 SOUTHEAST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 EAGLE POINT CORPORATE DR
BIRMINGHAM AL
35242-1900
US

IV. Provider business mailing address

17414 WASHINGTON ST
OMAHA NE
68135-3202
US

V. Phone/Fax

Practice location:
  • Phone: 205-855-2237
  • 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: FRANK EMSICK
Title or Position: CHIEF TECHNOLOGY OFFICER
Credential:
Phone: 402-651-6040