Provider Demographics
NPI:1366266280
Name:ENID UROLOGY ASSOCIATES, INC
Entity type:Organization
Organization Name:ENID UROLOGY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WORTHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-233-3230
Mailing Address - Street 1:615 E OKLAHOMA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5952
Mailing Address - Country:US
Mailing Address - Phone:580-233-3230
Mailing Address - Fax:580-233-0495
Practice Address - Street 1:615 E OKLAHOMA AVE STE 202
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5948
Practice Address - Country:US
Practice Address - Phone:580-233-3230
Practice Address - Fax:580-233-0495
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENID UROLOGY ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-08
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site