# ENID UROLOGY ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ENID UROLOGY ASSOCIATES, INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1871820175
- **Legal business name:** ENID UROLOGY ASSOCIATES, INC
- **Authorized official:** DR. JARRETT D KRUSKA MD (OWNER)
- **Authorized official phone:** (580) 233-3230

## Contact information

- **Practice address:** 6401 PATTERSON PKWY, ARKANSAS CITY, KS 67005-5701
- **Practice address phone:** (580) 233-3230
- **Practice address fax:** (580) 233-0698
- **Mailing address:** 615 E OKLAHOMA AVE, STE 202, ENID, OK 73701-5951
- **Mailing address phone:** (580) 233-3230
- **Mailing address fax:** (580) 233-0698

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 0434000 | KS | Yes |

## Other

- **Enumeration date:** 11/06/2009
- **Last updated:** 08/10/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0361060001 | MEDICARE DME | OK |
| 05 | — | 200057980A | — | OK |