Provider Demographics
NPI:1093356842
Name:CREW COMMUNITY HEALTH, INC
Entity Type:Organization
Organization Name:CREW COMMUNITY HEALTH, INC
Other - Org Name:CREW HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STERLING
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-605-2253
Mailing Address - Street 1:8601 COMMODITY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819
Mailing Address - Country:US
Mailing Address - Phone:407-605-2253
Mailing Address - Fax:855-750-3960
Practice Address - Street 1:8601 COMMODITY CIRCLE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-605-2252
Practice Address - Fax:855-750-3960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2024-02-06
Deactivation Date:2023-01-16
Deactivation Code:
Reactivation Date:2023-01-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113976900Medicaid