Northeast Arkansas Omfs, PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

NORTHEAST ARKANSAS OMFS, PLLC

Practice address

2609 Browns LN
Jonesboro, AR 72401-7227

Phone

(870) 931-3000

Fax

(870) 931-0190

NPI assigned

Jan 24, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Matthew L McDonough

Title

Ceo

Phone

(870) 931-3000

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642982400000",
    "number": "1427700111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2609 BROWNS LN",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724017227",
            "telephone_number": "870-931-3000",
            "fax_number": "870-931-0190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2609 BROWNS LN",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724017227",
            "telephone_number": "870-931-3000",
            "fax_number": "870-931-0190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ARKANSAS OMFS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-24",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A",
        "authorized_official_last_name": "MCDONOUGH",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-931-3000",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "225890679",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "insurance@drjamesphillips.com",
            "affiliation": "N",
            "address_1": "2609 Browns Ln",
            "city": "Jonesboro",
            "state": "AR",
            "country_code": "US",
            "postal_code": "724017227",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Northeast Arkansas Community Mental Health Center Inc
• Northeast Arkansas Community Mental Health Center Inc
• Northeast Arkansas Community Mental Health Center Inc
• Northeast Arkansas Dentistry
• Northeast Arkansas Health System LLC
• Northeast Arkansas Orthopaedic and Sports Physical Therapy, Inc.
• Northeast Arkansas Pain Medicine
• Northeast Arkansas Treatment Service
• Northland Hearing Center Inc
• Northland Hearing Centers, Inc.

• Oral and Maxillofacial Surgery (Dentist) in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.