Healthcare Provider Details

I. General information

NPI: 1922081504
Provider Name (Legal Business Name): AMERIGROUP FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W CYPRESS ST SUITE 900
TAMPA FL
33607-4156
US

IV. Provider business mailing address

4200 W CYPRESS ST SUITE 900
TAMPA FL
33607-4156
US

V. Phone/Fax

Practice location:
  • Phone: 813-830-6900
  • Fax: 757-222-2377
Mailing address:
  • Phone: 813-830-6900
  • Fax: 757-222-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number03-65-0311864
License Number StateFL

VIII. Authorized Official

Name: MR. DONALD VAN GILMORE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 813-830-6900