Provider Demographics
NPI:1396853438
Name:CATHERINE LARUFFA MD INC
Entity Type:Organization
Organization Name:CATHERINE LARUFFA MD INC
Other - Org Name:CATHERINE LARUFFA MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARUFFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-783-2600
Mailing Address - Street 1:700 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-1465
Mailing Address - Country:US
Mailing Address - Phone:937-783-2600
Mailing Address - Fax:937-783-3086
Practice Address - Street 1:700 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107-1465
Practice Address - Country:US
Practice Address - Phone:937-783-2600
Practice Address - Fax:937-783-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3561245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0028777OtherTRICARE
0120567OtherUNITED HEALTHCARE
OH0840693Medicaid
OH277932OtherAMERIGROUP OH MEDICAID
000000022715OtherANTHEM
4384406OtherAETNA
61245OtherHUMANA CHOICE CARE
289506103006OtherMEDICAL MUTUAL
61245OtherHUMANA CHOICE CARE
OH080166479Medicare ID - Type UnspecifiedRAILROAD RETIREMENT
=========00OtherWORKERS COMPENSATION
0120567OtherUNITED HEALTHCARE
OH5558150001Medicare NSC