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Organization
IDAHO UROLOGY 1 PLLC
Active
Organization
IDAHO UROLOGY 1 PLLC
Active
Other names
Mountain West Urology
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB BRYCE THATCHER (DO)
(208) 356-0004
Entity
Organization
Contact information
Practice address
30 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-2058
(208) 351-6363
Mailing address
30 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-2058
(208) 356-0004
(208) 356-0006
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
Primary
—
NULL
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
02/19/2026
Last updated
09/03/2026
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