Provider Demographics
NPI:1013893007
Name:THE COMMONWEALTH OF MASSACHUSETTS
Entity type:Organization
Organization Name:THE COMMONWEALTH OF MASSACHUSETTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-858-0110
Mailing Address - Street 1:627 RANDALL ROAD
Mailing Address - Street 2:HAMPDEN COUNTY SHERIFFS OFFICE MAIN INSTITUTION
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056
Mailing Address - Country:US
Mailing Address - Phone:413-858-0343
Mailing Address - Fax:413-589-0912
Practice Address - Street 1:627 RANDALL ROAD
Practice Address - Street 2:HAMPDEN COUNTY SHERIFFS OFFICE MAIN INSTITUTION
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056
Practice Address - Country:US
Practice Address - Phone:413-858-0343
Practice Address - Fax:413-589-0912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COMMONWEALTH OF MASSACHUSETTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health