Pediatric & Adolescent Clinic of Louisiana LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PEDIATRIC & ADOLESCENT CLINIC OF LOUISIANA LLC

Practice address

1806 Carter St
Vidalia, LA 71373-3115

Phone

(318) 336-7172

Fax

(318) 336-7176

NPI assigned

Apr 4, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David Timm, MDNPI 1023194867

Title

Medical Director

Phone

(601) 442-7676

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Rural health clinic certification: CCN 193883

Legal name

PEDIATRIC & ADOLESCENT CLINIC OF LOUISIANA LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Sep 4, 2007

Last certification

Aug 30, 2023

Ownership / control type

1A

Most recent change of ownership

Jan 1, 2025 (1 total)

Organization structure

LLCProprietary

Enrollment address

1806 Carter St
Vidalia, LA 71373-3115

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Alan Timm, M.D.

  • Pediatrics Physician
  • Natchez, MS
  • NPI 1023194867
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779753600000",
    "number": "1346092038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 HIGHLAND BLVD",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391204611",
            "telephone_number": "601-442-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1806 CARTER ST",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713733115",
            "telephone_number": "318-336-7172",
            "fax_number": "318-336-7176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC & ADOLESCENT CLINIC OF LOUISIANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-04",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A",
        "authorized_official_last_name": "TIMM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "601-442-7676",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jody Nichols
• Lisa Nichols
• Northland Hearing Centers, Inc.
• Lacey Ozburn, DPT
• Tiffany M Paul
• Perfusion Vascular Vidalia LLC
• Erika Perkins
• Mercedes Phipps
• Shanette Pinkston
• Arthuanna Plater, FNP

• Rural Health Clinic/Center in Vidalia, LA
• Providers in Vidalia, LA by specialty
• Rural Health Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.