Provider Demographics
NPI:1356582035
Name:DESIGNING HEALTH PA
Entity type:Organization
Organization Name:DESIGNING HEALTH PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-571-4325
Mailing Address - Street 1:2603 MAIN DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5278
Mailing Address - Country:US
Mailing Address - Phone:479-571-4325
Mailing Address - Fax:479-571-4329
Practice Address - Street 1:2603 MAIN DR
Practice Address - Street 2:SUITE 6
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5278
Practice Address - Country:US
Practice Address - Phone:479-571-4325
Practice Address - Fax:479-571-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2717207Q00000X
ARE0546208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710993654OtherNPPES - INDIVIDUAL NPI NUMBER
AR179094002OtherDESIGNING HEALTH, PA MEDICAID ORGANIZATIONAL NUMBER
AR167302001OtherMEDICAID PERSONAL NUMBER
AR5G182OtherMEDICARE PTAN