| Imagine | |
|
1400 Dixon Ave Lafayette CO 80026-2790 | |
| (303) 665-7789 | |
| (303) 665-2648 |
| Full Name | Imagine |
|---|---|
| Speciality | Clinic/Center |
| Location | 1400 Dixon Ave, Lafayette, Colorado |
| Authorized Official Name and Position | Robin Grey (CFO) |
| Authorized Official Contact | 3036416342 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Imagine 1400 Dixon St Lafayette CO 80026-2790 Ph: (303) 665-7789 | Imagine 1400 Dixon Ave Lafayette CO 80026-2790 Ph: (303) 665-7789 |
| NPI Number | 1508086794 |
|---|---|
| Provider Enumeration Date | 04/27/2007 |
| Last Update Date | 03/07/2024 |
| Certification Date | 03/05/2024 |
| Medicare PECOS PAC ID | 5597766089 |
|---|---|
| Medicare Enrollment ID | O20070125000573 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508086794 | NPI | - | NPPES |
| 30870216 | Medicaid | CO |
| Provider Name | Kristin M Brousseau |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1124092283 PECOS PAC ID: 5193626539 Enrollment ID: I20040119000059 |
| Provider Name | Jed Sickles Shapiro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396765558 PECOS PAC ID: 2062445133 Enrollment ID: I20050919000357 |
| Provider Name | Eva K Klemens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962627935 PECOS PAC ID: 5496843211 Enrollment ID: I20071113000073 |
| Provider Name | Morgan Elizabeth Barnes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790345056 PECOS PAC ID: 7416315692 Enrollment ID: I20230620002981 |
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