OrganizationActive
Fairview Heights Medical Group Sc
NPI 1073022000 · Multi-Specialty Clinic/Center · Saint Louis, MO
Provider details
- NPI number
- 1073022000
- Entity type
- Organization
- Primary specialty
- Multi-Specialty Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- John Ellena, Medical Director(314) 996-7644
Specialties & taxonomies
Ambulatory Health Care Facilities
- Medical Specialty Clinic/Center261QM2500X
Ambulatory Health Care Facilities
- Primary Care Clinic/Center261QP2300X
Ambulatory Health Care Facilities
Practice location
660 Mason Ridge Center Dr Ste 300
Saint Louis, MO 63141-8512
Phone: (314) 996-7644
Fax: (314) 996-7658
Approximate (ZIP-level) locationGet directions
Mailing address
660 Mason Ridge Center Dr Ste 300
Saint Louis, MO 63141-8512
Other names (DBA / former)
- Doing business as
- Bjc Medical Group of Illinois
Registry dates
- Enumerated
- 2017-09-21
- Last updated
- 2025-09-03
- Certified
- 2025-09-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.