Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Keith Michael McCullough, PA-C

Individual provider Physician Assistant · NPI 1447800552

Mr. Keith Michael McCullough, PA-C is a Physician Assistant in Coeur D Alene, Idaho. Qualified in 2019, 7 years ago. Practices with Radiology Associates of North Idaho PA, a 32-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
7
Licensed in
ID
In the registry since
2019
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

700 W Ironwood Dr Ste 175
Coeur D Alene, ID 83814-4401
Phone: (208) 625-6300
Fax: (208) 625-6301
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 — (208) 625-6360

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-1818 (ID)

Record details

NPI number1447800552
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 19, 2019
Last updated in NPPESAugust 3, 2025
Certification dateAugust 3, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Radiology Associates Of North Idaho Pa — 32 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Coeur D Alene