Provider Demographics
NPI:1114091220
Name:STEELHEAD MEDICAL LTD
Entity Type:Organization
Organization Name:STEELHEAD MEDICAL LTD
Other - Org Name:KRAIG C MCGEE MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-232-2146
Mailing Address - Street 1:333 N 18TH AVE
Mailing Address - Street 2:SUITE #B 3
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3358
Mailing Address - Country:US
Mailing Address - Phone:208-232-2146
Mailing Address - Fax:208-232-2770
Practice Address - Street 1:333 N 18TH AVE
Practice Address - Street 2:SUITE #B 3
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3358
Practice Address - Country:US
Practice Address - Phone:208-232-2146
Practice Address - Fax:208-232-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1377374Medicare ID - Type Unspecified