MEDICARE: PALMETTO ANESTHESIA, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	035105	FL

General Provider Information

NPI Number	:	1548571326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO ANESTHESIA, PA

Provider Business Mailing Address
First Line	:	405 HIAWATHA WAY
Second Line	:
City	:	MELBOURNE BEACH
State	:	FL
Zip	:	32951-3539
Country	:	US
Telephone Number	:	321-728-2108
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 HIAWATHA WAY
Second Line	:
City	:	MELBOURNE BEACH
State	:	FL
Zip	:	32951-3539
Country	:	US
Telephone Number	:	321-728-2108
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JUDY BUSE
Credential	:	CRNA
Telephone Number	:	321-728-2108

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	06/28/2010

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