Organization
STERLING PROVIDER GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORBIN BUNNAGE PA-C (PROVIDER/OWNER)
(208) 542-9111
Entity
Organization
Contact information
Practice address
47 DOC PERKES RD, AFTON, WY 83110-7703
(307) 885-3637
(307) 885-3638
Mailing address
740 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 542-9111
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53D2147193
CLIA
WY
Enumeration date
11/08/2019
Last updated
04/01/2025
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