Healthcare Provider Details

I. General information

NPI: 1073809141
Provider Name (Legal Business Name): AMY COLLEEN MCCLINTOCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 PHEASANT MEADOW DR STE 107
O FALLON MO
63368-7364
US

IV. Provider business mailing address

1074 BRYAN RD
O FALLON MO
63366-3400
US

V. Phone/Fax

Practice location:
  • Phone: 573-271-2927
  • Fax: 573-271-2928
Mailing address:
  • Phone: 573-271-2927
  • Fax: 573-271-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036159591
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2015026147
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number123806
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036159591
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2015026147
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: