Healthcare Provider Details

I. General information

NPI: 1689948242
Provider Name (Legal Business Name): HEALTHY INDIGENT POPULATIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 DELMAR
MEMPHIS TN
38105
US

IV. Provider business mailing address

PO BOX 41202
MEMPHIS TN
38174-1202
US

V. Phone/Fax

Practice location:
  • Phone: 901-213-8395
  • Fax:
Mailing address:
  • Phone: 901-213-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: FREDERIC DUNN DDS
Title or Position: CEO
Credential:
Phone: 901-213-8395