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General NPI Number Information
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NPI Number | 1104716240
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Entity Type | Organization
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Legal Business Name | COLORADO DEPARTMENT OF CORRECTIONS
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | HIGHWAY 50 EAST & EVANS BLVD
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City | CANON CITY
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State | CO
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Zip | 81212
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Country | US
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Telephone | 719-569-5644
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Fax | 719-269-5656
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Provider Business Mailing Address
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Address Line | PO BOX 300 CMC MEDICAL
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City | CANON CITY
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State | CO
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Zip | 81215
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Country | US
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Telephone | 719-269-5644
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. RANDOLPH MAUL
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Credential | MD
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Telephone | 712-306-2821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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