| Sterling Provider Group | |
|
260 East Moody Road Rexburg ID 83440 | |
| (208) 656-3553 | |
| (844) 523-9111 |
| Full Name | Sterling Provider Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 260 East Moody Road, Rexburg, Idaho |
| Authorized Official Name and Position | Corbin Bunnage (PROVIDER/OWNER) |
| Authorized Official Contact | 2085429111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sterling Provider Group 740 S Woodruff Ave Idaho Falls ID 83401-5285 Ph: (208) 542-9111 | Sterling Provider Group 260 East Moody Road Rexburg ID 83440 Ph: (208) 656-3553 |
| NPI Number | 1407564123 |
|---|---|
| Provider Enumeration Date | 11/10/2022 |
| Last Update Date | 06/17/2026 |
| Certification Date | 06/17/2026 |
| Medicare PECOS PAC ID | 2264773373 |
|---|---|
| Medicare Enrollment ID | O20240828004347 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407564123 | NPI | - | NPPES |
| 13D2273429 | Other | ID | CLIA |
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