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

Fairview Heights Medical Group, SC

Organization Internal Medicine Physician · NPI 1811392210

Fairview Heights Medical Group, SC is an Internal Medicine Physician in Saint Louis, Missouri. Licensed in Illinois. Registered with an NPI since 2014.

Licensed in
IL
In the registry since
2014

Practice location Address checks out

670 Mason Ridge Center Dr Ste 300
Saint Louis, MO 63141-8573
Phone: (314) 996-7644
Fax: (314) 996-7658
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 036.108281 (IL)

Record details

NPI number1811392210
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official John Ellena — Medical Director · (314) 996-3434
NPI enumeratedOctober 28, 2014
Last updated in NPPESNovember 12, 2014
Mailing address670 Mason Ridge Center Dr, Saint Louis, MO 63141-8573

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