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
Last updated
Jul 14, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF COLORADOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

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

Addresses

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

  • Arrowhead Correctional Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Fort Lyon Correctional Facility103 organizations share this tax ID, including this one
Part of
Fort Lyon Correctional Facility

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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.