Healthcare Provider Details

I. General information

NPI: 1699193656
Provider Name (Legal Business Name): BUZYKE ALLIANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2014
Last Update Date: 07/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 FOOTHILLS RD SUITE B
LAS CRUCES NM
88011-4672
US

IV. Provider business mailing address

PO BOX 13969
LAS CRUCES NM
88013-3969
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-9837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberMD2008-0255
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD2008-0255
License Number StateNM

VIII. Authorized Official

Name: DR. CHIBUZO UKAEGBU
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 575-556-9837