Provider Demographics
NPI:1538059670
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 777
Mailing Address - Street 2:CSP MEDICAL
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81215
Mailing Address - Country:US
Mailing Address - Phone:719-269-5180
Mailing Address - Fax:719-269-5192
Practice Address - Street 1:HIGHWAY 50 EAST & EVANS BLVD
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212
Practice Address - Country:US
Practice Address - Phone:719-269-5180
Practice Address - Fax:719-269-5192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health