MEDICARE: MICHAEL D PALSGROVE CRNA

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
3	430071338	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G1981X	OTHER	FL	BX OF FL - NON PAR
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356347595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D PALSGROVE CRNA

Provider Business Mailing Address
First Line	:	1497 W AVON BLVD
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-9511
Country	:	US
Telephone Number	:	863-453-0419
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	01/08/2015

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