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General NPI Number Information
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NPI Number | 1962554063
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Entity Type | Organization
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Legal Business Name | CHERRY LANE FAMILY CLINIC, PA
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 1001 N MERIDIAN RD
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City | MERIDIAN
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State | ID
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Zip | 83642-1610
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Country | US
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Telephone | 208-884-4800
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Fax | 208-884-4802
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Provider Business Mailing Address
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Address Line | 1001 N MERIDIAN RD
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City | MERIDIAN
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State | ID
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Zip | 83642-1610
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Country | US
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Telephone | 208-884-4800
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Fax | 208-884-4802
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY MCHUGH
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Credential | M.D.
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Telephone | 208-884-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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