# STERLING PROVIDER GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639713589
- **Authorized official:** CORBIN BUNNAGE PA-C (PROVIDER/OWER)
- **Authorized official phone:** (208) 542-9111

## Contact information

- **Practice address:** 630 E 1400 N STE 150, LOGAN, UT 84341-2549
- **Practice address phone:** (435) 915-4465
- **Practice address fax:** (435) 799-3664
- **Mailing address:** 740 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
- **Mailing address phone:** (208) 542-9111
- **Mailing address fax:** (208) 542-9114

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | Yes |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/04/2019
- **Last updated:** 06/17/2026