Provider Demographics
NPI:1598872269
Name:BROOKVIEW WOMENS CENTER PLLC
Entity Type:Organization
Organization Name:BROOKVIEW WOMENS CENTER PLLC
Other - Org Name:CAROLINA GYNECOLOGIC ONCOLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PITTAWAY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:336-765-1464
Mailing Address - Street 1:3333 BROOKVIEW HILLS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5661
Mailing Address - Country:US
Mailing Address - Phone:336-765-1464
Mailing Address - Fax:336-760-2492
Practice Address - Street 1:3333 BROOKVIEW HILLS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5661
Practice Address - Country:US
Practice Address - Phone:336-765-1464
Practice Address - Fax:336-760-2492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0248JOtherBLUE CROSS BLUE SHIELD
74-07470OtherUNITED HEALTHCARE
81281OtherMEDCOST
458OtherPARTNERS NATIONAL HEALTH
NC8967838Medicaid
2096077AMedicare ID - Type Unspecified