Provider Demographics
NPI:1164582409
Name:TIRPACK MEDICAL PROCEDURES, LTD
Entity Type:Organization
Organization Name:TIRPACK MEDICAL PROCEDURES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:S
Authorized Official - Last Name:TIRPRAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-487-1203
Mailing Address - Street 1:10 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35503-8260
Mailing Address - Country:US
Mailing Address - Phone:205-487-1203
Mailing Address - Fax:205-487-1205
Practice Address - Street 1:2010 PATTON CHAPEL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5782
Practice Address - Country:US
Practice Address - Phone:205-487-1203
Practice Address - Fax:205-487-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20629207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherTRICARE
AL=========OtherTRICARE