MEDICARE: MBS ADVANTAGE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	207927	IL
2	235Z00000X	Speech-Language Pathologist	102623	MO
3	235Z00000X	Speech-Language Pathologist	146004057	IL
4	208D00000X	General Practice Physician	000014833	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	121947	OTHER	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083612253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MBS ADVANTAGE INC

Provider Business Mailing Address
First Line	:	11618 GRAVOIS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-3014
Country	:	US
Telephone Number	:	314-842-1900
Fax Number	:	314-842-9185

Provider Business Practice Location Address
First Line	:	11618 GRAVOIS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-3014
Country	:	US
Telephone Number	:	314-842-1900
Fax Number	:	314-842-9185

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. JEAN L FOSTER
Credential	:	MA/CCC-SLP, BRS-S
Telephone Number	:	314-842-1900

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	03/11/2012

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Directions to “MBS ADVANTAGE INC ” Practice Location

Language	Start Address	Practice Location

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