# STATE DIAGNOSTIC CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255684395
- **Authorized official:** MR. ESSAYAS T MICHAEL (MEMBER)
- **Authorized official phone:** (202) 290-4282

## Contact information

- **Practice address:** 13111 WESTHEIMER RD, SUITE \#212, HOUSTON, TX 77077-5546
- **Practice address phone:** (832) 230-3804
- **Practice address fax:** (832) 230-3839
- **Mailing address:** 13111 WESTHEIMER RD, SUITE \#212, HOUSTON, TX 77077-5546
- **Mailing address phone:** (832) 230-3804
- **Mailing address fax:** (832) 230-3839

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/25/2012
- **Last updated:** 10/25/2012