Healthcare Provider Details

I. General information

NPI: 1386196665
Provider Name (Legal Business Name): COLORADO DEPARTMENT OF CORRECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49030 STATE HWY 71
LIMON CO
80826-0001
US

IV. Provider business mailing address

49030 STATE HWY 71
LIMON CO
80826-0001
US

V. Phone/Fax

Practice location:
  • Phone: 719-775-7653
  • Fax: 719-775-7651
Mailing address:
  • Phone: 719-775-7653
  • Fax: 719-775-7651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberDEN.00104436
License Number StateCO

VIII. Authorized Official

Name: DR. RANDOLPH MAUL
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 719-306-2821