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Pediatric & Adolescent Clinic LLC

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Company Details

Name: Pediatric & Adolescent Clinic LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 20 Nov 2023 (2 years ago)
Business ID: 1419373
ZIP code: 39120
County: Adams
State of Incorporation: MISSISSIPPI
Principal Office Address: 308 Highland BlvdNatchez, MS 39120

Agent

Name Role Address
David Timm MD Agent 308 Highland Blvd, Natchez, MS 39120

Organizer

Name Role Address
John Christian Organizer 522 Main Street, Natchez, MS 39120

Member

Name Role Address
David Timm Member 308 Highland Blvd, Natchez, MS 39120

National Provider Identifier

NPI Number:
1952163206
Certification Date:
2024-01-24

Authorized Person:

Name:
DR. DAVID A TIMM
Role:
MEDICAL DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
261QR1300X - Rural Health Clinic/Center
Is Primary:
No
Selected Taxonomy:
208000000X - Pediatrics Physician
Is Primary:
Yes

Contacts:

Fax:
6014429590

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2025-03-07 Annual Report For Pediatric & Adolescent Clinic LLC
Annual Report LLC Filed 2024-02-05 Annual Report For Pediatric & Adolescent Clinic LLC
Formation Form Filed 2023-11-20 Formation For Pediatric & Adolescent Clinic LLC

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Date of last update: 04 Jun 2025

Sources: Company Profile on Mississippi Secretary of State Website