Healthcare Provider Details

I. General information

NPI: 1679435226
Provider Name (Legal Business Name): MBOC OKLAHOMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 NW 192ND ST
EDMOND OK
73012-4481
US

IV. Provider business mailing address

16 VILLAGE LN STE 200
COLLEYVILLE TX
76034-2948
US

V. Phone/Fax

Practice location:
  • Phone: 682-900-6631
  • Fax: 682-503-7428
Mailing address:
  • Phone: 682-316-1856
  • Fax: 682-503-7428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BYRON MCLAUGHLIN
Title or Position: VP, REVENUE CYCLE MANAGEMENT
Credential:
Phone: 682-350-5880