Provider Demographics
NPI:1811971013
Name:AMERIGROUP ILLINOIS, INC.
Entity type:Organization
Organization Name:AMERIGROUP ILLINOIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-214-0400
Mailing Address - Street 1:211 W WACKER DR
Mailing Address - Street 2:SUITE 1350
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1217
Mailing Address - Country:US
Mailing Address - Phone:312-214-0400
Mailing Address - Fax:312-214-0424
Practice Address - Street 1:211 W WACKER DR
Practice Address - Street 2:SUITE 1350
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1217
Practice Address - Country:US
Practice Address - Phone:312-214-0400
Practice Address - Fax:312-214-0424
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid