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General NPI Number Information
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NPI Number | 1588399745
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Entity Type | Organization
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Legal Business Name | WJG MULTISPECIALTY CLINIC PC
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 194 PLEASANT ST STE 7
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City | CONCORD
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State | NH
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Zip | 03301-2952
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Country | US
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Telephone | 603-208-3085
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Fax | 603-217-5371
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Provider Business Mailing Address
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Address Line | PO BOX 53302
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City | PHOENIX
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State | AZ
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Zip | 85072-3302
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Country | US
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Telephone | 844-614-2354
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Fax | 844-278-8635
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Authorized Official
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Title or Position | SENIOR REIMBURSEMENT MANAGER
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Name | CHARLES MICHAEL BUCY
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Credential |
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Telephone | 717-383-0392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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