Provider Demographics
NPI:1114547486
Name:HEALTHY LIVING PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:HEALTHY LIVING PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAPASYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDALAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-449-6644
Mailing Address - Street 1:200 S RIVERSHIRE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3485
Mailing Address - Country:US
Mailing Address - Phone:936-234-5400
Mailing Address - Fax:888-714-0097
Practice Address - Street 1:200 S RIVERSHIRE DR STE 200
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3485
Practice Address - Country:US
Practice Address - Phone:936-234-5400
Practice Address - Fax:888-714-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty