Organization
IDAHO UROLOGY 1 PLLC
Active
Other names
Mountain West Urology
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB THATCHER DO (SURGEON)
(208) 351-6363
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
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
02/19/2026
Last updated
08/05/2026
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