=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609167501
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAYOU PULMONARY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2011
-----------------------------------------------------
Last Update Date | 04/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4224 HOUMA BLVD SUITE 600
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70006-2933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-456-7456
-----------------------------------------------------
Fax | 504-456-7453
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5321 COCOS PLUMOSAS DR
-----------------------------------------------------
City | KENNER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70065-2320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-220-3831
-----------------------------------------------------
Fax | 504-456-7453
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. MATTHEW L SCHUETTE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 504-220-3831
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 019956
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------