Provider Demographics
NPI:1689562241
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 6000
Mailing Address - Street 2:SCF MEDICAL
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751
Mailing Address - Country:US
Mailing Address - Phone:970-521-8910
Mailing Address - Fax:970-521-8815
Practice Address - Street 1:12101 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-8428
Practice Address - Country:US
Practice Address - Phone:970-521-8910
Practice Address - Fax:970-521-8815
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