| Fort Lyon Correctional Facility | |
|
30999 County Rd 15 Fort Lyon CO 81038 | |
| (719) 456-3222 | |
| Not Available |
| Full Name | Fort Lyon Correctional Facility |
|---|---|
| Speciality | Clinic/center |
| Location | 30999 County Rd 15, Fort Lyon, Colorado |
| Authorized Official Name and Position | Paul O. Lastrella (PHYSICIAN) |
| Authorized Official Contact | 7194563222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Lyon Correctional Facility 2862 S Circle Dr Colorado Springs CO 80906-4101 Ph: () - | Fort Lyon Correctional Facility 30999 County Rd 15 Fort Lyon CO 81038 Ph: (719) 456-3222 |
| NPI Number | 1629132121 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629132121 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |