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General NPI Number Information
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NPI Number | 1083612253
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Entity Type | Organization
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Legal Business Name | MBS ADVANTAGE INC
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 03/11/2012
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Provider Practice Location Address
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Address Line | 11618 GRAVOIS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63126-3014
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Country | US
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Telephone | 314-842-1900
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Fax | 314-842-9185
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Provider Business Mailing Address
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Address Line | 11618 GRAVOIS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63126-3014
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Country | US
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Telephone | 314-842-1900
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Fax | 314-842-9185
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JEAN L FOSTER
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Credential | MA/CCC-SLP, BRS-S
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Telephone | 314-842-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 207927
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 102623
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146004057
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 000014833
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License Number State | MO
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