Provider Demographics
NPI:1073940862
Name:MTB MANAGEMENT, LLC
Entity Type:Organization
Organization Name:MTB MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEM
Authorized Official - Prefix:
Authorized Official - First Name:MARKUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-605-2292
Mailing Address - Street 1:PO BOX 53182
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73152-3182
Mailing Address - Country:US
Mailing Address - Phone:405-605-2292
Mailing Address - Fax:405-605-2266
Practice Address - Street 1:1032 S DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5209
Practice Address - Country:US
Practice Address - Phone:405-605-2292
Practice Address - Fax:405-605-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management