Provider Demographics
NPI:1770307449
Name:WINDHAM AND RENTROP UROLOGY PLLC
Entity type:Organization
Organization Name:WINDHAM AND RENTROP UROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONACIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-324-1018
Mailing Address - Street 1:1207 HIGHWAY 182 W STE B
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-9013
Mailing Address - Country:US
Mailing Address - Phone:662-295-3296
Mailing Address - Fax:
Practice Address - Street 1:1207 HIGHWAY 182 W STE B
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9013
Practice Address - Country:US
Practice Address - Phone:662-295-3296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site