Organization
BIG TREE MEDICAL GROUP LLC
Active
Other names
BIG TREE MEDICAL GROUP LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTONY NGUYEN VANBANG MD (PRIMARY PROVIDER)
(720) 323-0621
Entity
Organization
Contact information
Practice address
1701 S FEDERAL BLVD, DENVER, CO 80219-4898
(720) 323-0621
(303) 934-4036
Mailing address
1701 S FEDERAL BLVD, DENVER, CO 80219-4898
(720) 323-0621
(303) 934-4036
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DR.0054747
COLORADO DEPARTMENT OF REGULATORY AGENCIES DIVISION OF PROFESSIONS AND OCCUPATIO
CO
Enumeration date
02/16/2022
Last updated
03/08/2022
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