FAIRVIEW HEIGHTS MEDICAL GROUP SC NPI 1073022000

NPI Information

NPI: 1073022000
Provider Name: FAIRVIEW HEIGHTS MEDICAL GROUP SC

Doing Business As: BJC MEDICAL GROUP OF ILLINOIS

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS, MO
ZIP 63141
Phone: (314) 996-7644
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FAIRVIEW HEIGHTS MEDICAL GROUP SC is a multi-specialty clinic center in Saint Louis, MO. FAIRVIEW HEIGHTS MEDICAL GROUP SC NPI is 1073022000. The provider is registered as an organization entity type.
The provider Is Doing Business As Bjc Medical Group Of Illinois.

The provider's business location address is:

670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS, MO
ZIP 63141-573
Phone: (314) 996-7644
Fax: (314) 996-7658

The provider's authorized official is John T Ellena .
The authorized official title is Medical Director and has the following contact phone number (314) 996-7644.

The enumeration date for this NPI number is 9/21/2017 and was last updated on 7/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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