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Organization
ENID UROLOGY ASSOCIATES
Active
Organization
ENID UROLOGY ASSOCIATES
Active
Parent organization
ENID UROLOGY ASSOCIATES, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ENID UROLOGY ASSOCIATES, INC
Authorized official
DR. JARRETT D KRUSKA MD (OWNER)
(580) 233-3230
Entity
Organization
Contact information
Practice address
6401 PATTERSON PKWY, ARKANSAS CITY, KS 67005-5701
(580) 233-3230
(580) 233-0698
Mailing address
615 E OKLAHOMA AVE, STE 202, ENID, OK 73701-5951
(580) 233-3230
(580) 233-0698
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0434000
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0361060001
MEDICARE DME
OK
05
—
200057980A
—
OK
Enumeration date
11/06/2009
Last updated
08/10/2011
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