DESIGNING HEALTH PA NPI 1356582035

NPI Information

DESIGNING HEALTH PA is a general practice in Fayetteville, AR. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee DESIGNING HEALTH PA NPI is 1356582035. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Main Street Medical.

The provider's business location address is:

2603 MAIN DR
SUITE 6
FAYETTEVILLE, AR
ZIP 72704-278
Phone: (479) 571-4325
Fax: (479) 571-4329

The provider's authorized official is Scott Fedosky .
The authorized official title is Physician and has the following contact phone number (479) 571-4325.

The CLIA number assigned to this NPI record is 04D1064841 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/10/2009 and was last updated on 4/8/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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