State Diagnostic Clinic, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

STATE DIAGNOSTIC CLINIC, LLC

Practice address

13111 Westheimer Rd
Suite #212
Houston, TX 77077-5546

Phone

(832) 230-3804

Fax

(832) 230-3839

NPI assigned

Oct 25, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Essayas T Michael

Title

Member

Phone

(202) 290-4282

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1255684395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13111 WESTHEIMER RD",
            "address_2": "SUITE #212",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770775546",
            "telephone_number": "832-230-3804",
            "fax_number": "832-230-3839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13111 WESTHEIMER RD",
            "address_2": "SUITE #212",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770775546",
            "telephone_number": "832-230-3804",
            "fax_number": "832-230-3839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE DIAGNOSTIC CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "MICHAEL",
        "authorized_official_first_name": "ESSAYAS",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "202-290-4282",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Houston, TX
• Providers in Houston, TX by specialty
• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.