# IDAHO UROLOGY 1 PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Mountain West Urology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316890270
- **Authorized official:** JACOB BRYCE THATCHER (DO)
- **Authorized official phone:** (208) 356-0004

## Contact information

- **Practice address:** 30 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-2058
- **Practice address phone:** (208) 351-6363
- **Mailing address:** 30 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-2058
- **Mailing address phone:** (208) 356-0004
- **Mailing address fax:** (208) 356-0006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/19/2026
- **Last updated:** 09/03/2026