Healthcare Provider Details

I. General information

NPI: 1275624918
Provider Name (Legal Business Name): PATRICIA SOUTHWORTH, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N LIMESTONE ST
SPRINGFIELD OH
45503-3609
US

IV. Provider business mailing address

821 N LIMESTONE ST
SPRINGFIELD OH
45503-3609
US

V. Phone/Fax

Practice location:
  • Phone: 937-322-8977
  • Fax: 937-322-5456
Mailing address:
  • Phone: 937-322-8977
  • Fax: 937-322-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD020413E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35.062754
License Number StateOH

VIII. Authorized Official

Name: DR. PATRICIA ANN SOUTHWORTH
Title or Position: DOCTOR
Credential: M.D.
Phone: 937-322-8977