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General NPI Number Information
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NPI Number | 1669530192
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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 | 12/05/2006
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 1410 W 13TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-1961
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Country | US
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Telephone | 719-583-5550
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Fax | 719-583-5560
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Provider Business Mailing Address
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Address Line | PO BOX 3 SCCF MEDICAL
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City | PUEBLO
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State | CO
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Zip | 81002
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Country | US
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Telephone | 719-583-5550
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Fax | 719-583-5560
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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 | 719-306-2821
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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 | 391
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License Number State | CO
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