NPIMap

Organization Active NPI

Colorado Department of Corrections

  • Prison Health Clinic/Center
  • Pueblo, CO
National Provider Identifier
1669530192
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prison Health Clinic/CenterTaxonomy code 261QP2400X
License
391 Issued in CO
Legal business name
COLORADO DEPARTMENT OF CORRECTIONS
Practice address
1410 W 13TH St
Pueblo, CO 81003-1961
Phone
(719) 583-5550
Fax
(719) 583-5560
NPI assigned
Dec 5, 2006
Last updated
Jun 24, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF COLORADOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 24, 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
(719) 306-2821

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prison Health Clinic/Center 261QP2400X 391 CO Primary

Addresses

Primary practice location

1410 W 13TH St
Pueblo, CO 81003-1961

Mailing address

PO Box 3
SCCF Medical
Pueblo, CO 81002
Phone (719) 583-5550

Other names 1

  • San Carlos Correctional Facility 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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750723200000",
    "number": "1669530192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3",
            "address_2": "SCCF MEDICAL",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "81002",
            "telephone_number": "719-583-5550",
            "fax_number": "719-583-5560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 W 13TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810031961",
            "telephone_number": "719-583-5550",
            "fax_number": "719-583-5560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO DEPARTMENT OF CORRECTIONS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF COLORADO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A",
        "authorized_official_last_name": "MAUL",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "719-306-2821",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Prison Health",
            "state": "CO",
            "license": "391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Carlos Correctional Facility",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.