1710263082 NPI number — AMERIGROUP LOUISIANA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710263082 NPI number — AMERIGROUP LOUISIANA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERIGROUP LOUISIANA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710263082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3850 N CAUSEWAY BLVD
Provider Second Line Business Mailing Address:
SUITE 1160
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70002-1752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-962-6452
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3850 N CAUSEWAY BLVD
Provider Second Line Business Practice Location Address:
SUITE 1160
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70002-1752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-962-6452
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BUCHER
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
757-962-6452

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2162519 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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