| Immersiv Health Of Colorado, Pllc | |
|
1715 61st Ave Ste 103 Greeley CO 80634-7989 | |
| (877) 551-6650 | |
| (855) 694-4656 |
| Full Name | Immersiv Health Of Colorado, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1715 61st Ave Ste 103, Greeley, Colorado |
| Authorized Official Name and Position | Son Han (CEO) |
| Authorized Official Contact | 5128699323 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Immersiv Health Of Colorado, Pllc 382 Ne 191st St Ste 93920 Miami FL 33179-3899 Ph: (877) 551-6650 | Immersiv Health Of Colorado, Pllc 1715 61st Ave Ste 103 Greeley CO 80634-7989 Ph: (877) 551-6650 |
| NPI Number | 1043043466 |
|---|---|
| Provider Enumeration Date | 08/21/2024 |
| Last Update Date | 06/25/2025 |
| Medicare PECOS PAC ID | 5395278246 |
|---|---|
| Medicare Enrollment ID | O20241030002387 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043043466 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Leslie Michelle Mudge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407337504 PECOS PAC ID: 7719221928 Enrollment ID: I20181128003291 |
| Provider Name | Emily M Keen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104336189 PECOS PAC ID: 4082941810 Enrollment ID: I20190815003533 |
| Provider Name | Jodie Gallegos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235626466 PECOS PAC ID: 9436589322 Enrollment ID: I20200416001317 |
| Provider Name | Kiana Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386329068 PECOS PAC ID: 9133583248 Enrollment ID: I20230907003360 |
| Provider Name | Jason Litzinger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497254460 PECOS PAC ID: 5698038586 Enrollment ID: I20231129000507 |
| Provider Name | Rebecca Jones |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1104260819 PECOS PAC ID: 5294058335 Enrollment ID: I20241118001211 |
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