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General NPI Number Information
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NPI Number | 1417147059
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Entity Type | Organization
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Legal Business Name | AMERIGROUP COMMUNITY CARE OF SOUTH CAROLI
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 250 BERRYHILL RD SUITE 210
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City | COLUMBIA
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State | SC
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Zip | 29210-6470
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Country | US
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Telephone | 803-551-2377
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Fax |
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Provider Business Mailing Address
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Address Line | 250 BERRYHILL ROAD SUITE 210
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City | COLUMBIA
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State | SC
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Zip | 29210-6470
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Country | US
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Telephone | 803-551-2377
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT, REGULATORY S
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Name | MS. SHARON BRUMLEY
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Credential |
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Telephone | 757-962-6452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 161350
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License Number State | SC
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