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STERLING PROVIDER GROUP, LLC

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Company Details

Name: STERLING PROVIDER GROUP, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 07 Sep 2018 (7 years ago)
Financial Date End: 30 Sep 2025
Entity Number: 625121
Place of Formation: IDAHO
File Number: 625121
ZIP code: 83401
County: Bonneville County
Principal Address: 740 S WOODRUFF AVE IDAHO FALLS, ID 83401-5285

Agent

Name Role Address
Scott Brown Agent 740 S WOODRUFF, IDAHO FALLS, ID 83401

Member

Name Role Address Appointed On
Corbin Bunnage Member 740 S WOODRUFF AVE, IDAHO FALLS, ID 83401 2020-09-22

National Provider Identifier

NPI Number:
1316793615
Certification Date:
2023-12-29

Authorized Person:

Name:
CORBIN BUNNAGE
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QX0100X - Occupational Medicine Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QU0200X - Urgent Care Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2085429114
Fax:
9862568881

Filing

Filing Name Filing Number Filing date
Application for Reinstatement 0005861216 2024-08-14
Dissolution/Revocation - Administrative 0005019407 2022-12-08
Annual Report 0004402257 2021-09-03
Annual Report 0004009253 2020-09-22
Annual Report 0003610374 2019-08-30

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Date of last update: 05 Jul 2025

Sources: Idaho Secretary of State