OrganizationActive
Fairview Heights Medical Group Sc
NPI 1407912736 · Medical Specialty Clinic/Center · Bridgeton, MO
Provider details
- NPI number
- 1407912736
- Entity type
- Organization
- Primary specialty
- Medical Specialty Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- John Ellena, Medical Director(314) 434-8828
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
3165 Mckelvey Rd
210
Bridgeton, MO 63044-2550
Phone: (314) 996-8148
Fax: (314) 996-8134
Approximate (ZIP-level) locationGet directions
Mailing address
11155 Dunn Rd
Saint Louis, MO 63136-6150
Registry dates
- Enumerated
- 2006-12-29
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.