Provider Demographics
NPI:1679059687
Name:BUPDOC LLC
Entity Type:Organization
Organization Name:BUPDOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:NALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-445-0383
Mailing Address - Street 1:3220 N ACADEMY BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5115
Mailing Address - Country:US
Mailing Address - Phone:719-445-0383
Mailing Address - Fax:719-375-0953
Practice Address - Street 1:3220 N ACADEMY BLVD STE 3
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5115
Practice Address - Country:US
Practice Address - Phone:719-445-0383
Practice Address - Fax:719-375-0953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32462207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty