# FORT LYON CORRECTIONAL FACILITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629132121
- **Authorized official:** PAUL O. LASTRELLA M.D. (PHYSICIAN)
- **Authorized official phone:** (719) 456-3222

## Contact information

- **Practice address:** 30999 COUNTY RD 15, FORT LYON, CO 81038
- **Practice address phone:** (719) 456-3222
- **Mailing address:** 2862 S CIRCLE DR, COLORADO SPRINGS, CO 80906-4101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/20/2006
- **Last updated:** 08/22/2020