Provider Demographics
NPI:1255831665
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:WILIAM
Authorized Official - Middle Name:REDMOND
Authorized Official - Last Name:FROST
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:719-226-4511
Mailing Address - Street 1:1250 ACADEMY PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3708
Mailing Address - Country:US
Mailing Address - Phone:719-226-4511
Mailing Address - Fax:
Practice Address - Street 1:1250 ACADEMY PARK LOOP
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3708
Practice Address - Country:US
Practice Address - Phone:719-226-4511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center