OrganizationActive
Colorado Department of Corrections
NPI 1104716240 · Prison Health Clinic/Center · Canon City, CO
Provider details
- NPI number
- 1104716240
- Entity type
- Organization
- Primary specialty
- Prison Health Clinic/CenterAmbulatory Health Care Facilities
- Parent organization
- State of Colorado
- Authorized official
- Randolph Maul, Chief Medical Officer
Practice location
Highway 50 East & Evans Blvd
Canon City, CO 81212
Phone: (719) 569-5644
Fax: (719) 269-5656
Mailing address
Po Box 300
Canon City, CO 81215
Registry dates
- Enumerated
- 2025-07-09
- Last updated
- 2025-07-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.