=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396853438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATHERINE LARUFFA MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2006
-----------------------------------------------------
Last Update Date | 10/07/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 S BROADWAY ST
-----------------------------------------------------
City | BLANCHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45107-1465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-783-2600
-----------------------------------------------------
Fax | 937-783-3086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 S BROADWAY ST
-----------------------------------------------------
City | BLANCHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45107-1465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-783-2600
-----------------------------------------------------
Fax | 937-783-3086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT CEO
-----------------------------------------------------
Name | MRS. CATHERINE LARUFFA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 937-783-2600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 3561245
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------