MEDICARE: WINDHAM AND RENTROP UROLOGY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1770307449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDHAM AND RENTROP UROLOGY PLLC

Provider Business Mailing Address
First Line	:	1207 HIGHWAY 182 W STE B
Second Line	:
City	:	STARKVILLE
State	:	MS
Zip	:	39759-9013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 HIGHWAY 182 W STE B
Second Line	:
City	:	STARKVILLE
State	:	MS
Zip	:	39759-9013
Country	:	US
Telephone Number	:	662-295-3296
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DONACIANA COLEMAN
Credential	:
Telephone Number	:	662-324-1097

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	01/08/2026

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