Organization Name: | MBS ADVANTAGE INC |
NPI Number: | 1083612253 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEAN L FOSTER (PRESIDENT) |
Mailing Address: | 11618 Gravois Rd Saint Louis |
State: | MO US |
Postal Code: | 631263014 |
Phone Number: | 3148421900 |
Fax Number: | 3148429185 |
NPI Enumeration Date: | 07/12/2005 |
NPI Last Update Date: | 03/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 207927 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |