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Colorado Department Of Corrections

Clinic/Center, Prison Health in Canon City, CO. Organization (NPI-2).

NPI number1720978752
StatusActive
Last updated in NPPESJul 14, 2025

Details

NPI
1720978752
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 codeDescriptionLicenseStatePrimary
261QP2400X Clinic/Center, Prison Health––Yes

Other names

  • Fremont Correctional Facility (Other Name)

Practice location

Highway 50 East & Evans Blvd
Canon City, CO 81212

Phone 719-269-5374 · Fax 719-269-5363

Mailing address

Po Box 999
Canon City, CO 81215-0999

Phone 719-269-5053 · Fax 719-269-5090

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

All 6 Prison Health Clinic/Center providers in Canon City · All 907 providers in Canon City

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