Organization
FAIRVIEW HEIGHTS MEDICAL GROUP SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ELLENA M.D. (MEDICAL DIRECTOR)
(314) 434-8828
Entity
Organization
Contact information
Practice address
3165 MCKELVEY RD, 210, BRIDGETON, MO 63044-2550
(314) 996-8148
(314) 996-8134
Mailing address
11155 DUNN RD, 108N, SAINT LOUIS, MO 63136-6150
(314) 355-6779
(314) 355-4209
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
12/29/2006
Last updated
08/22/2020
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