Provider Demographics
NPI:1235027889
Name:COLORADO DEPARTMENT OF CORRECTIONS
Entity type:Organization
Organization Name:COLORADO DEPARTMENT OF CORRECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-306-2821
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:LVCF MEDICAL
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81002
Mailing Address - Country:US
Mailing Address - Phone:719-583-5851
Mailing Address - Fax:719-583-5852
Practice Address - Street 1:1401 W 17TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-1929
Practice Address - Country:US
Practice Address - Phone:719-583-5851
Practice Address - Fax:719-583-5852
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health