Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Fairview Heights Medical Group SC

Organization Medical Specialty Clinic/Center · NPI 1407912736

Fairview Heights Medical Group SC is a Medical Specialty Clinic/Center in Bridgeton, Missouri. Registered with an NPI since 2006.

In the registry since
2006
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Practice location Address checks out

3165 McKelvey Rd 210
Bridgeton, MO 63044-2550
Phone: (314) 996-8148
Fax: (314) 996-8134
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Specialty Clinic/Center (primary) Taxonomy 261QM2500X

Record details

NPI number1407912736
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official John Ellena — Medical Director · (314) 434-8828
NPI enumeratedDecember 29, 2006
Last updated in NPPESAugust 22, 2020
Mailing address11155 Dunn Rd, 108n, Saint Louis, MO 63136-6150