FAIRVIEW HEIGHTS MEDICAL GROUP, SC
Osteopathic Medicine at Mason Ridge Center Dr, Saint Louis, MO

License number
Missouri 036.108281
Category
Osteopathic Medicine
Type
Internal Medicine
Owner
Name: JOHN T ELLENA MD
Title: MEDICAL DIRECTOR
Phone: (314) 996-3434
Address
Address
670 Mason Ridge Center Dr STE 300, Saint Louis, MO 63141
National Provider ID: 1811392210
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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Fairview Heights Medical Group SC

11155 Dunn Rd, Saint Louis, MO 63136

Industry:
Internist
Phone:
(314) 953-8799 (Phone)

Fairview Heights Medical Group SC

1010 Old Des Peres Rd, Saint Louis, MO 63131

Industry:
Cardiologist, Internist
Phone:
(314) 238-2535 (Phone)

FAIRVIEW HEIGHTS MEDICAL GROUP, S.C

Saint Louis, MO 63141

Registration:
Mar 21, 1997
State ID:
59322974
Business type:
Domestic Bca
Entity State:
IL
Expiration:
Perpetual
Agent:
C T Corporation System,208 So Lasalle St SUITE 814, Chicago, IL 60604 (Physical)

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