Healthcare Provider Details

I. General information

NPI: 1164582409
Provider Name (Legal Business Name): TIRPACK MEDICAL PROCEDURES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 PATTON CHAPEL RD SUITE 103
HOOVER AL
35216-5782
US

IV. Provider business mailing address

10 DAVIS DR
JASPER AL
35503-8260
US

V. Phone/Fax

Practice location:
  • Phone: 205-487-1203
  • Fax: 205-487-1205
Mailing address:
  • Phone: 205-487-1203
  • Fax: 205-487-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20629
License Number StateAL

VIII. Authorized Official

Name: DR. JILL S TIRPRAC
Title or Position: OWNER
Credential: MD
Phone: 205-487-1203