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General NPI Number Information
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NPI Number | 1750327201
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Entity Type | Organization
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Legal Business Name | SOUTHSHORE LUNG CENTER, LLC
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 4224 HOUMA BLVD SUITE 600
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City | METAIRIE
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State | LA
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Zip | 70006-2933
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Country | US
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Telephone | 504-456-7456
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Fax | 504-456-7453
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Provider Business Mailing Address
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Address Line | 4224 HOUMA BLVD SUITE 600
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City | METAIRIE
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State | LA
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Zip | 70006-2933
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Country | US
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Telephone | 504-456-7456
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Fax | 504-456-7453
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW L SCHUETTE
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Credential | MD
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Telephone | 504-456-7456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 019956
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License Number State | LA
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