Organization
MBS ADVANTAGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JEAN L FOSTER MA/CCC-SLP, BRS-S (PRESIDENT)
(314) 842-1900
Entity
Organization
Contact information
Practice address
11618 GRAVOIS RD, SAINT LOUIS, MO 63126-3014
(314) 842-1900
(314) 842-9185
Mailing address
11618 GRAVOIS RD, SAINT LOUIS, MO 63126-3014
(314) 842-1900
(314) 842-9185
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
000014833
MO
208D00000X
General Practice Physician
207927
IL
235Z00000X
Speech-Language Pathologist
102623
MO
235Z00000X
Speech-Language Pathologist
146004057
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121947
BCBS
—
05
—
271325663
—
IL
05
—
500893409
—
MO
Enumeration date
07/12/2005
Last updated
03/11/2012
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