MEDICARE: DR. MARIO A CAMPOS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	RS2016-0466	NM
2	2084P0800X	Psychiatry Physician	9071762	ID
3	2084P0800X	Psychiatry Physician	MD2020-0322	NM

General Provider Information

NPI Number	:	1508217928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO A CAMPOS M.D.

Provider Business Mailing Address
First Line	:	1109 W MYRTLE ST STE 200
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-6975
Country	:	US
Telephone Number	:	208-706-6375
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 W MYRTLE ST STE 200
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-6975
Country	:	US
Telephone Number	:	208-706-6375
Fax Number	:	208-706-6395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	02/12/2026

Similar Medicare Providers

1467115428 — SCOTT STANTLIFF LCPC
Practice Location Address:

1109 W MYRTLE ST STE 200
BOISE, ID
83702-6975

Practice Phone: 208-706-6375
Practice Fax: 208-706-6395

1205326642 — CARLY J WILSON MS, LAT, ATC
Practice Location Address:

1109 W MYRTLE ST STE 200
BOISE, ID
83702-6975

Practice Phone: 208-489-4300
Practice Fax:

1417441270 — JAMES LIAW
Practice Location Address:

1109 W MYRTLE ST STE 220
BOISE, ID
83702-6975

Practice Phone: 208-385-3720
Practice Fax:

1043939804 — HANNAH HOWELL
Practice Location Address:

1109 W MYRTLE ST STE 200
BOISE, ID
83702-6975

Practice Phone: 208-706-2663
Practice Fax:

1033991559 — CRISTINA MEDRANO-ENRIQUEZ
Practice Location Address:

1109 W MYRTLE ST STE 200
BOISE, ID
83702-6975

Practice Phone: 208-706-6375
Practice Fax: 208-706-6395

1871790642 — DR. SCOTT ANTHONY WINK PHARMD
Practice Location Address:

6975 E GHOST BAR ST
BOISE, ID
83716-8834

Practice Phone: 843-297-0585
Practice Fax:

Directions to “ DR. MARIO A CAMPOS M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.