# DESIGNING HEALTH PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Main Street Medical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356582035
- **Authorized official:** SCOTT FEDOSKY MD (PHYSICIAN)
- **Authorized official phone:** (479) 571-4325

## Contact information

- **Practice address:** 2603 MAIN DR, SUITE 6, FAYETTEVILLE, AR 72704-5278
- **Practice address phone:** (479) 571-4325
- **Practice address fax:** (479) 571-4329
- **Mailing address:** 2603 MAIN DR, SUITE 6, FAYETTEVILLE, AR 72704-5278
- **Mailing address phone:** (479) 571-4325
- **Mailing address fax:** (479) 571-4329

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | E2717 | AR | — |
| 208D00000X | General Practice Physician | E0546 | AR | Yes |

## Other

- **Enumeration date:** 03/10/2009
- **Last updated:** 04/08/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 167302001 | MEDICAID PERSONAL NUMBER | AR |
| 01 | — | 1710993654 | NPPES - INDIVIDUAL NPI NUMBER | — |
| 01 | — | 179094002 | DESIGNING HEALTH, PA MEDICAID ORGANIZATIONAL NUMBER | AR |
| 01 | — | 5G182 | MEDICARE PTAN | AR |