MEDICARE: PALSGROVES SWEET DREAMS INC

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	RN1705052	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	430071338	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	AK357	OTHER	FL	BX OF FL - NON PAR

General Provider Information

NPI Number	:	1225034473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALSGROVES SWEET DREAMS INC

Provider Business Mailing Address
First Line	:	400 E 10TH ST
Second Line	:
City	:	WACONIA
State	:	MN
Zip	:	55387-4552
Country	:	US
Telephone Number	:	952-442-9771
Fax Number	:	952-442-3620

Provider Business Practice Location Address
First Line	:	3601 S HIGHLANDS AVE
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-5418
Country	:	US
Telephone Number	:	863-382-7500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL PALSGROVE
Credential	:	CRNA
Telephone Number	:	863-382-7500

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/07/2008

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