Provider Demographics
NPI:1710263082
Name:AMERIGROUP LOUISIANA, INC.
Entity Type:Organization
Organization Name:AMERIGROUP LOUISIANA, INC.
Other - Org Name:AMERIGROUP COMMUNITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-962-6452
Mailing Address - Street 1:3850 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 1160
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-1752
Mailing Address - Country:US
Mailing Address - Phone:757-962-6452
Mailing Address - Fax:
Practice Address - Street 1:3850 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 1160
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-1752
Practice Address - Country:US
Practice Address - Phone:757-962-6452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2162519Medicaid