Provider Demographics
NPI:1326022542
Name:AMERIGROUP OHIO, INC.
Entity Type:Organization
Organization Name:AMERIGROUP OHIO, INC.
Other - Org Name:AMERIGROUP COMMUNITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-733-2300
Mailing Address - Street 1:10123 ALLIANCE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4714
Mailing Address - Country:US
Mailing Address - Phone:513-733-2300
Mailing Address - Fax:513-733-0516
Practice Address - Street 1:10123 ALLIANCE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4714
Practice Address - Country:US
Practice Address - Phone:513-733-2300
Practice Address - Fax:513-733-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00307302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization