Provider Demographics
NPI:1841274040
Name:AMERIGROUP TEXAS, INC.
Entity type:Organization
Organization Name:AMERIGROUP TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, HEALTH PLAN OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ZORETIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-490-6900
Mailing Address - Street 1:1200 E COPELAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-1344
Mailing Address - Country:US
Mailing Address - Phone:817-861-7700
Mailing Address - Fax:817-548-7125
Practice Address - Street 1:1200 E COPELAND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-1344
Practice Address - Country:US
Practice Address - Phone:817-861-7700
Practice Address - Fax:817-548-7125
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
TX12677302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1=========7001Medicaid