Healthcare Provider Details

I. General information

NPI: 1063167211
Provider Name (Legal Business Name): BIG TREE MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 03/08/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S FEDERAL BLVD
DENVER CO
80219-4898
US

IV. Provider business mailing address

1701 S FEDERAL BLVD
DENVER CO
80219-4898
US

V. Phone/Fax

Practice location:
  • Phone: 720-323-0621
  • Fax: 303-934-4036
Mailing address:
  • Phone: 720-323-0621
  • Fax: 303-934-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTONY NGUYEN VANBANG
Title or Position: PRIMARY PROVIDER
Credential: MD
Phone: 720-323-0621