Healthcare Provider Details

I. General information

NPI: 1710263082
Provider Name (Legal Business Name): AMERIGROUP LOUISIANA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 N CAUSEWAY BLVD SUITE 1160
METAIRIE LA
70002-1752
US

IV. Provider business mailing address

3850 N CAUSEWAY BLVD SUITE 1160
METAIRIE LA
70002-1752
US

V. Phone/Fax

Practice location:
  • Phone: 757-962-6452
  • Fax:
Mailing address:
  • Phone: 757-962-6452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. GEORGE STEPHEN BUCHER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 757-962-6452