Provider Demographics
NPI:1407727993
Name:WOUND100 SOUTHEAST LLC
Entity type:Organization
Organization Name:WOUND100 SOUTHEAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF TECHNOLOGY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:EMSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-651-6040
Mailing Address - Street 1:17414 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3202
Mailing Address - Country:US
Mailing Address - Phone:402-651-6040
Mailing Address - Fax:
Practice Address - Street 1:4000 EAGLE POINT CORPORATE DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-1900
Practice Address - Country:US
Practice Address - Phone:205-855-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty