OrganizationActive
Colorado Department of Corrections
NPI 1235027889 · Prison Health Clinic/Center · Pueblo, CO
Provider details
- NPI number
- 1235027889
- Entity type
- Organization
- Primary specialty
- Prison Health Clinic/CenterAmbulatory Health Care Facilities
- Parent organization
- State of Colorado
- Organization subpart
- Yes
- Authorized official
- Randolph Maul, Chief Medical Officer(719) 306-2821
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
1401 W 17th St
Pueblo, CO 81003-1929
Phone: (719) 583-5851
Fax: (719) 583-5852
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 3
Pueblo, CO 81002
Other names (DBA / former)
- Other name
- Lavista Correctional Facility
Registry dates
- Enumerated
- 2025-06-24
- Last updated
- 2025-07-14
- Certified
- 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.