Healthcare Provider Details

I. General information

NPI: 1841274040
Provider Name (Legal Business Name): AMERIGROUP TEXAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E COPELAND RD SUITE 200
ARLINGTON TX
76011-1344
US

IV. Provider business mailing address

1200 E COPELAND RD SUITE 200
ARLINGTON TX
76011-1344
US

V. Phone/Fax

Practice location:
  • Phone: 817-861-7700
  • Fax: 817-548-7125
Mailing address:
  • Phone: 817-861-7700
  • Fax: 817-548-7125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number12677
License Number StateTX

VIII. Authorized Official

Name: MR. RICHARD CHARLES ZORETIC
Title or Position: EVP, HEALTH PLAN OPERATIONS
Credential:
Phone: 757-490-6900