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General NPI Number Information
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NPI Number | 1073809141
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Entity Type | Individual
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Provider Name | AMY COLLEEN MCCLINTOCK M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 3449 PHEASANT MEADOW DR STE 107
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City | O FALLON
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State | MO
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Zip | 63368-7364
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Country | US
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Telephone | 573-271-2927
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Fax | 573-271-2928
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Provider Business Mailing Address
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Address Line | 1074 BRYAN RD
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City | O FALLON
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State | MO
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Zip | 63366-3400
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Country | US
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Telephone | 573-271-2927
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Fax | 573-271-2928
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 036159591
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2015026147
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 123806
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036159591
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 2015026147
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License Number State | MO
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