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FAIRVIEW HEIGHTS MEDICAL GROUP SC
NPI 1407912736
Clinic/Center - Medical Specialty in Bridgeton, MO

Active since December 29, 2006
3165 MCKELVEY RD, 210, BRIDGETON, MO 63044(314) 996-8148(314) 996-8134 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Fairview Heights Medical Group Sc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAIRVIEW HEIGHTS MEDICAL GROUP SC (NPI 1407912736) is a healthcare organization registered as a medical specialty in Bridgeton, Missouri and active in the NPI registry since December 2006. The organization lists John Ellena, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1407912736
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameFAIRVIEW HEIGHTS MEDICAL GROUP SC
Location Address3165 MCKELVEY RD, 210Bridgeton, MO 63044-2550
Mailing Address11155 Dunn Rd, 108nSaint Louis, MO 63136-6150 · (314) 355-6779 · Fax (314) 355-4209
Phone(314) 996-8148
Fax(314) 996-8134
Organization SubpartNo
Authorized OfficialJohn EllenaMedical Director · (314) 434-8828
Enumeration DateDecember 29, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1407912736 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
Definition

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

3165 MCKELVEY RD, Bridgeton, MO 63044
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LINDSAY MARIE AUSTIN B.S.
Social Worker (Clinical)
3165 MCKELVEY RD
BRIDGETON, MO 63044
St. Louis County (314) 206-3901
KIMBERLY VOGLER M.S.
Case Manager/Care Coordinator
3165 MCKELVEY RD
BRIDGETON, MO 63044
St. Louis County (314) 803-3322
MS. SARAH LORD
Social Worker
3165 MCKELVEY RD, SUITE 200
BRIDGETON, MO 63044
St. Louis County (314) 206-3952
MS. ERIN C MORRIS BS
Social Worker
3165 MCKELVEY RD, SUITE 200
BRIDGETON, MO 63044
St. Louis County (314) 206-3900
MS. KAPRIS BENEA CLARK BACHELORS OF SCIENCE
Community Health Worker
3165 MCKELVEY RD, SUITE 200
BRIDGETON, MO 63044
St. Louis County (314) 206-3900
TINA CHAREMON DIXON BSW
Social Worker
3165 MCKELVEY RD
BRIDGETON, MO 63044
St. Louis County (314) 206-3900
MR. GEORGE JOESEPH KNOECHEL
Counselor (Mental Health)
3165 MCKELVEY RD, SUITE 200
BRIDGETON, MO 63044
St. Louis County (314) 206-3956
MISS DINAH HARTWELL MSW
Social Worker
3165 MCKELVEY RD
BRIDGETON, MO 63044
St. Louis County (314) 206-3900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fairview Heights Medical Group Sc's NPI number?

The NPI number for Fairview Heights Medical Group Sc is 1407912736. It was assigned to this organization in the NPPES registry on December 29, 2006.

Where is Fairview Heights Medical Group Sc located?

Fairview Heights Medical Group Sc is located at 3165 Mckelvey Rd 210, Bridgeton, MO 63044. The listed phone number is (314) 996-8148.

What is Fairview Heights Medical Group Sc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

When was this NPI record last updated?

The NPPES record for Fairview Heights Medical Group Sc was last updated on August 22, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.