Organization
DESIGNING HEALTH PA
Active
Other names
Main Street Medical
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT FEDOSKY MD (PHYSICIAN)
(479) 571-4325
Entity
Organization
Contact information
Practice address
2603 MAIN DR, SUITE 6, FAYETTEVILLE, AR 72704-5278
(479) 571-4325
(479) 571-4329
Mailing address
2603 MAIN DR, SUITE 6, FAYETTEVILLE, AR 72704-5278
(479) 571-4325
(479) 571-4329
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
E2717
AR
208D00000X
General Practice Physician
Primary
E0546
AR
Other
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
Enumeration date
03/10/2009
Last updated
04/08/2014
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