1548078405 NPI number — MBO TENNESSEE, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548078405 NPI number — MBO TENNESSEE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MBO TENNESSEE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548078405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 VILLAGE LN STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEYVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76034-2948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-900-6631
Provider Business Mailing Address Fax Number:
800-416-8145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 COOL SPRINGS BLVD STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-6449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-900-6631
Provider Business Practice Location Address Fax Number:
800-416-8145
Provider Enumeration Date:
12/24/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCLAUGHLIN
Authorized Official First Name:
BYRON
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, REV CYCLE MANAGEMENT
Authorized Official Telephone Number:
682-350-5880

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)