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NPI Code Detail

MEDICARE: WOUND100 ILLINOIS LLC

MEDICARE: WOUND100 ILLINOIS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2500XMedical Specialty Clinic/Center
2261Q00000XClinic/Center

General Provider Information

NPI Number : 1043187040
Entity Type Code : Organization
Provider Name (Legal Business Name) : WOUND100 ILLINOIS LLC
Provider Business Mailing Address
First Line : 19681 CHICAGO ST APT A
Second Line :
City : ELKHORN
State : NE
Zip : 68022-6525
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 122 S MICHIGAN AVE STE 1390
Second Line :
City : CHICAGO
State : IL
Zip : 60603-6036
Country : US
Telephone Number : 402-651-6040
Fax Number : 312-449-6572
Authorized Official
Title or Position : CHIEF TRANSFORMATION OFFICER
Name : FRANK EMSICK
Credential :
Telephone Number : 402-651-6040
Provider Enumeration Date : 10/22/2025
Last Update Date : 10/22/2025

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Directions to “WOUND100 ILLINOIS LLC ” Practice Location

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