Individual ProviderJoseph CampbellPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address190 E Bannock St, Boise, ID 83712-6241(208) 381-2094PECOS EnrollmentBased on the most recent information from CMS, provider Joseph Campbell is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1467828186Provider TypeIndividualFull NameCampbell, JosephCredentialPA-CGenderMaleSole ProprietorNoEnumeration Date8/17/2015Last Updated7/2/2019Contact InformationPractice LocationPractice Address190 E Bannock St, Boise, ID 83712-6241Phone(208) 381-2094Fax(208) 381-1791Mailing LocationMailing Address190 E Bannock St, Boise, ID 83712-6241Phone(208) 381-2094Fax(208) 381-1791Provider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerIDPA-1748DescriptionOtherIssuerSTATE OF IDAHO BOARD OF MEDICINEIdahoID2068745DescriptionMedicaidIssuerUnlistedWashington