Fort Lyon Correctional Facility | |
30999 County Rd 15 Fort Lyon CO 81038 | |
(719) 456-3222 | |
Not Available |
Full Name | Fort Lyon Correctional Facility |
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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 |
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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 |
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Provider Enumeration Date | 12/20/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1629132121 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |