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General NPI Number Information
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NPI Number | 1407727993
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Entity Type | Organization
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Legal Business Name | WOUND100 SOUTHEAST LLC
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 4000 EAGLE POINT CORPORATE DR
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City | BIRMINGHAM
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State | AL
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Zip | 35242-1900
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Country | US
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Telephone | 205-855-2237
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Fax |
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Provider Business Mailing Address
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Address Line | 17414 WASHINGTON ST
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City | OMAHA
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State | NE
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Zip | 68135-3202
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Country | US
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Telephone | 402-651-6040
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Fax |
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Authorized Official
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Title or Position | CHIEF TECHNOLOGY OFFICER
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Name | FRANK EMSICK
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Credential |
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Telephone | 402-651-6040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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