=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679435226
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MBOC OKLAHOMA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2025
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1140 NW 192ND ST
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73012-4481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-900-6631
-----------------------------------------------------
Fax | 682-503-7428
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 VILLAGE LN STE 200
-----------------------------------------------------
City | COLLEYVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76034-2948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-316-1856
-----------------------------------------------------
Fax | 682-503-7428
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP, REVENUE CYCLE MANAGEMENT
-----------------------------------------------------
Name | MR. BYRON MCLAUGHLIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 682-350-5880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------