MEDICARE: AMERIGROUP FLORIDA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	03-65-0311864	FL

General Provider Information

NPI Number	:	1922081504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERIGROUP FLORIDA, INC.

Provider Business Mailing Address
First Line	:	4200 W CYPRESS ST
Second Line	:	SUITE 900
City	:	TAMPA
State	:	FL
Zip	:	33607-4156
Country	:	US
Telephone Number	:	813-830-6900
Fax Number	:	757-222-2377

Provider Business Practice Location Address
First Line	:	4200 W CYPRESS ST
Second Line	:	SUITE 900
City	:	TAMPA
State	:	FL
Zip	:	33607-4156
Country	:	US
Telephone Number	:	813-830-6900
Fax Number	:	757-222-2377

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. DONALD VAN GILMORE
Credential	:
Telephone Number	:	813-830-6900

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	09/17/2008

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