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General NPI Number Information
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NPI Number | 1164066015
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Entity Type | Organization
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Legal Business Name | STERLING PROVIDER GROUP
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 609 S HIGHWAY 91 # A
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City | RICHMOND
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State | UT
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Zip | 84333-1208
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Country | US
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Telephone | 435-294-3215
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Fax | 435-294-2960
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Provider Business Mailing Address
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Address Line | 740 S WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-5285
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Country | US
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Telephone | 208-542-9111
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Fax | 208-542-9114
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | CORBIN BUNNAGE
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Credential | PA-C
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Telephone | 208-542-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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