Healthcare Provider Details

I. General information

NPI: 1982534574
Provider Name (Legal Business Name): THOMAS JAMES KIBLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 W BROADWAY ST
IDAHO FALLS ID
83402-2996
US

IV. Provider business mailing address

2265 W BROADWAY ST
IDAHO FALLS ID
83402-2996
US

V. Phone/Fax

Practice location:
  • Phone: 208-524-7400
  • Fax: 208-524-8004
Mailing address:
  • Phone: 208-524-7400
  • Fax: 208-524-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7481313
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: