Colorado Department Of Corrections
Clinic/Center, Prison Health in Canon City, CO. Organization (NPI-2).
Details
- NPI
- 1538059670
- Entity type
- Organization (NPI-2)
- Legal business name
- Colorado Department Of Corrections
- Organization subpart
- Yes
- Enumeration date
- Jul 9, 2025
- Certification date
- Jul 14, 2025
- Last updated
- Jul 14, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2400X | Clinic/Center, Prison Health | – | – | Yes |
Other names
- Colorado State Penitentiary (Other Name)
Practice location
Highway 50 East & Evans BlvdCanon City, CO 81212
Phone 719-269-5180 · Fax 719-269-5192
Mailing address
Po Box 777Csp Medical
Canon City, CO 81215
Phone 719-269-5180 · Fax 719-269-5192
Authorized official
Randolph Maul
Chief Medical Officer
7193062821
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Prison Health Clinic/Center providers in Canon City, CO
- Colorado Department Of CorrectionsNPI 1104716240
- Colorado Department Of CorrectionsNPI 1326936022
- Colorado Department Of CorrectionsNPI 1518857531
- Colorado Department Of CorrectionsNPI 1720978752
- Colorado Department Of CorrectionsNPI 1780574715
All 6 Prison Health Clinic/Center providers in Canon City · All 907 providers in Canon City
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