Provider Demographics
NPI:1083612253
Name:MBS ADVANTAGE INC
Entity Type:Organization
Organization Name:MBS ADVANTAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA/CCC-SLP, BRS-S
Authorized Official - Phone:314-842-1900
Mailing Address - Street 1:11618 GRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-3014
Mailing Address - Country:US
Mailing Address - Phone:314-842-1900
Mailing Address - Fax:314-842-9185
Practice Address - Street 1:11618 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-3014
Practice Address - Country:US
Practice Address - Phone:314-842-1900
Practice Address - Fax:314-842-9185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2012-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207927208D00000X
MO000014833208D00000X
MO102623235Z00000X
IL146004057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500893409Medicaid
121947OtherBCBS
IL271325663Medicaid
121947OtherBCBS
IL271325663Medicaid