<Unavail>

LBN: Fairview Heights Medical Group Sc
<Unavail> is an health care organization with primary practice located at 660 Mason Ridge Center Dr Ste 300 , Saint Louis MO 63141-8512. The organization recently has 3 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Multi-Specialty, Ambulatory Health Care Facilities / Medical Specialty, Ambulatory Health Care Facilities / Primary Care. Ambulatory Health Care Facilities / Multi-Specialty is the primary health care specialty. Fairview Heights Medical Group Sc can be contacted via phone (314) 996-7644, or through Ellena, John T via phone (314) 996-7644.

Contact Information

Primary practice address
660 Mason Ridge Center Dr Ste 300 Saint Louis MO 63141-8512
Phone: (314) 996-7644
Fax: (314) 996-7658
Website:
Map and Directions
Authorized official contact:
Name: Ellena, John T Doctor of Medicine (MD)
Phone: (314) 996-7644

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Multi-Specialty 261QM1300X
Ambulatory Health Care Facilities / Medical Specialty 261QM2500X
Ambulatory Health Care Facilities / Primary Care 261QP2300X

Profile Details

NPI number 1073022000
LBN Legal business name Fairview Heights Medical Group Sc
DBA Doing business as <Unavail>
Authorized official Ellena, John T Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Sep 21st, 2017
Last updated Sep 3rd, 2025 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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