NPIMap

Organization Active NPI

Colorado Department of Corrections

  • Prison Health Clinic/Center
  • Canon City, CO
National Provider Identifier
1104716240
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prison Health Clinic/CenterTaxonomy code 261QP2400X
Legal business name
COLORADO DEPARTMENT OF CORRECTIONS
Practice address
Highway 50 East & Evans Blvd
Canon City, CO 81212
Phone
(719) 569-5644
Fax
(719) 269-5656
NPI assigned
Jul 9, 2025
Organization subpart
Yes
Parent organization
STATE OF COLORADOAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Dr. Randolph Maul, MD
Title
Chief Medical Officer
Phone
(712) 306-2821

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

National Provider Directory
Tax ID family
Colorado State Veterans Nursing Home (102 organizations share this tax ID)
Part of
Colorado State Veterans Nursing Home

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Prison Health Clinic/Center 261QP2400X Primary

Addresses

NPPES NPI Registry

Primary practice location

Highway 50 East & Evans Blvd
Canon City, CO 81212

Mailing address

PO Box 300
CMC Medical
Canon City, CO 81215
Phone (719) 269-5644

Other names 1

NPPES NPI Registry
  • Arrowhead Correctional Center Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 14, 2025.

{
    "created_epoch": "1752019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752451200000",
    "number": "1104716240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 300",
            "address_2": "CMC MEDICAL",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "81215",
            "telephone_number": "719-269-5644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HIGHWAY 50 EAST & EVANS BLVD",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "81212",
            "telephone_number": "719-569-5644",
            "fax_number": "719-269-5656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO DEPARTMENT OF CORRECTIONS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF COLORADO",
        "enumeration_date": "2025-07-09",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A",
        "authorized_official_last_name": "MAUL",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "712-306-2821",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Prison Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arrowhead Correctional Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Canon City, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.