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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