| NPI | 1518857531 |
|---|---|
| Other Name | FOUR MILE CORRECTIONAL CENTER |
| Entity Type | Organization |
| Authorized Contact | RANDOLPH MAUL Chief Medical Officer 719-306-2821 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2400X Clinic/Center, Prison Health |
| Enumeration Date | 2025-07-09 |
| Last Update Date | 2025-07-14 |