NPIMap

Organization Active NPI

David Alan Timm

Doing business as Pediatric & Adolescent Clinic

  • Pediatrics Physician
  • Vidalia, LA
National Provider Identifier
1710015318
Registry record updated Dec 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
016299 Issued in LA
Legal business name
DAVID ALAN TIMM
Doing business as
Pediatric & Adolescent Clinic
Practice address
1806 Carter St
Vidalia, LA 71373-3115
Phone
(318) 336-7172
Fax
(318) 336-7176
NPI assigned
Mar 2, 2007
Last updated
Dec 9, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2009

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

Authorized official

Name
Dr. David Alan Timm, MDNPI 1023194867
Title
Owner
Phone
(601) 442-7676

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APO4933 LA
Family Nurse Practitioner 363LF0000X APO4870 LA
Pediatrics Physician 208000000X MD016299 LA
Pediatrics Physician 208000000X 016299 LA Primary

Addresses

Primary practice location

1806 Carter St
Vidalia, LA 71373-3115

Mailing address

1806 Carter St
Vidalia, LA 71373-3115
Phone (318) 336-7172

Other identifiers 1

IdentifierTypeStateIssuer
1021829MedicaidLA

Other names 1

  • PEDIATRIC & ADOLESCENT CLINIC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
David Alan Timm4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260316800000",
    "number": "1710015318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": "DAVID ALAN TIMM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2009-12-09",
        "status": "A",
        "authorized_official_last_name": "TIMM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-442-7676",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "APO4933",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "APO4870",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "MD016299",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "016299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1021829",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEDIATRIC & ADOLESCENT CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vidalia, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.