Healthcare Provider Details

I. General information

NPI: 1952939548
Provider Name (Legal Business Name): MACKENZIE ADCOX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N 1ST ST STE 280
BOISE ID
83702-6132
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-345-6546
  • Fax: 208-345-1213
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number2981818
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: