Provider Demographics
NPI:1962485540
Name:AMERIGROUP CORPORATION
Entity Type:Organization
Organization Name:AMERIGROUP CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JMAES
Authorized Official - Middle Name:GORDEN
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-962-6452
Mailing Address - Street 1:4425 CORPORATION LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3103
Mailing Address - Country:US
Mailing Address - Phone:757-962-6452
Mailing Address - Fax:757-222-2377
Practice Address - Street 1:4425 CORPORATION LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3103
Practice Address - Country:US
Practice Address - Phone:757-962-6452
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:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization