Provider Demographics
NPI:1619712155
Name:CONCORDIA WOUND CARE LLC
Entity type:Organization
Organization Name:CONCORDIA WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNOLDO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:ALEMAN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:414-550-6002
Mailing Address - Street 1:5750 GRANDSCAPE BLVD APT 11402
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6996
Mailing Address - Country:US
Mailing Address - Phone:414-323-0260
Mailing Address - Fax:
Practice Address - Street 1:1299 FARNAM ST STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1857
Practice Address - Country:US
Practice Address - Phone:414-323-0260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No251J00000XAgenciesNursing Care
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty