MEDICARE: THE COMMONWEALTH OF MASSACHUSETTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2400X	Prison Health Clinic/Center

General Provider Information

NPI Number	:	1043154826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COMMONWEALTH OF MASSACHUSETTS

Provider Business Mailing Address
First Line	:	24 LONG POND RD.
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360
Country	:	US
Telephone Number	:	508-830-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	PLYMOUTH COUNTY SHERIFF'S OFFICE
Second Line	:	24 LONG POND RD.
City	:	PLYMOUTH
State	:	MA
Zip	:	02360
Country	:	US
Telephone Number	:	508-830-6200
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	JULIE A O'SULLIVAN
Credential	:
Telephone Number	:	508-732-1854

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “THE COMMONWEALTH OF MASSACHUSETTS ” Practice Location

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