Provider Demographics
NPI:1942598628
Name:ENID UROLOGY ASSOCIATES, INC
Entity Type:Organization
Organization Name:ENID UROLOGY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING/TREATING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-233-3230
Mailing Address - Street 1:615 E OKLAHOMA AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5951
Mailing Address - Country:US
Mailing Address - Phone:580-233-3230
Mailing Address - Fax:580-233-0698
Practice Address - Street 1:609 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2911
Practice Address - Country:US
Practice Address - Phone:580-233-3230
Practice Address - Fax:580-233-0698
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENID UROLOGY ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK24087OtherSTATE LICENSE
OK32898OtherOBNDD
OK200037540AMedicaid
OK200037540AMedicaid
OK200037540AMedicaid
OK24087OtherSTATE LICENSE