Organization
STERLING PROVIDER GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORBIN BUNNAGE PA-C (PROVIDER/OWER)
(208) 542-9111
Entity
Organization
Contact information
Practice address
630 E 1400 N STE 150, LOGAN, UT 84341-2549
(435) 915-4465
(435) 799-3664
Mailing address
740 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 542-9111
(208) 542-9114
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46D2147193
CLIA
UT
Enumeration date
11/04/2019
Last updated
07/27/2024
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