Organization
FAIRVIEW HEIGHTS MEDICAL GROUP SC
Active
Organization
FAIRVIEW HEIGHTS MEDICAL GROUP SC
Active
Other names
BJC MEDICAL GROUP OF ILLINOIS
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN T ELLENA MD (MEDICAL DIRECTOR)
(314) 996-7644
Entity
Organization
Contact information
Practice address
660 MASON RIDGE CENTER DR STE 300, SAINT LOUIS, MO 63141-8512
(314) 996-7644
(314) 996-7658
Mailing address
660 MASON RIDGE CENTER DR STE 300, SAINT LOUIS, MO 63141-8512
(314) 996-7663
(314) 996-7658
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
09/21/2017
Last updated
09/03/2025
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