Provider Demographics
NPI:1922081504
Name:AMERIGROUP FLORIDA, INC.
Entity Type:Organization
Organization Name:AMERIGROUP FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-830-6900
Mailing Address - Street 1:4200 W CYPRESS ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-4156
Mailing Address - Country:US
Mailing Address - Phone:813-830-6900
Mailing Address - Fax:757-222-2377
Practice Address - Street 1:4200 W CYPRESS ST
Practice Address - Street 2:SUITE 900
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4156
Practice Address - Country:US
Practice Address - Phone:813-830-6900
Practice Address - Fax:757-222-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL03-65-0311864302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization