| Organization Name: | STATE DIAGNOSTIC CLINIC, LLC |
| NPI Number: | 1255684395 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ESSAYAS T MICHAEL (MEMBER) |
| Mailing Address: | 13111 Westheimer Rd Suite #212 Houston |
| State: | TX US |
| Postal Code: | 770775546 |
| Phone Number: | 8322303804 |
| Fax Number: | 8322303839 |
| NPI Enumeration Date: | 10/25/2012 |
| NPI Last Update Date: | 10/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |