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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