Sterling Provider Group
Clinic/Center, Rural Health in Evanston, WY. Organization (NPI-2).
NPI number1164044962
StatusActive
Last updated in NPPESJun 17, 2026
Details
- NPI
- 1164044962
- Entity type
- Organization (NPI-2)
- Legal business name
- Sterling Provider Group
- Organization subpart
- No
- Enumeration date
- May 14, 2020
- Certification date
- Jun 17, 2026
- Last updated
- Jun 17, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR1300X | Clinic/Center, Rural Health | – | – | Yes |
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | |
| 261QX0100X | Clinic/Center, Occupational Medicine | – | – | |
| 261QU0200X | Clinic/Center, Urgent Care | – | – | |
| 261QP2300X | Clinic/Center, Primary Care | – | – |
Practice location
1952 Harrison Dr Ste 1Evanston, WY 82930-3241
Phone 208-542-9111 · Fax 208-542-9114
Mailing address
740 S Woodruff AveIdaho Falls, ID 83401-5285
Phone 208-542-9111 · Fax 208-542-9114
Authorized official
Corbin Bunnage
Provider/Owner
2085429111
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