Provider Demographics
NPI:1225034473
Name:PALSGROVES SWEET DREAMS INC
Entity Type:Organization
Organization Name:PALSGROVES SWEET DREAMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PALSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:863-382-7500
Mailing Address - Street 1:400 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:952-442-9771
Mailing Address - Fax:952-442-3620
Practice Address - Street 1:3601 S HIGHLANDS AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5418
Practice Address - Country:US
Practice Address - Phone:863-382-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1705052367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL430071338OtherRAILROAD MEDICARE
FL311532100Medicaid
FLAK357OtherBX OF FL - NON PAR
FL311532100Medicaid
FLAK357OtherBX OF FL - NON PAR