# CHERRY LANE FAMILY CLINIC, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962554063
- **Authorized official:** TIMOTHY MCHUGH M.D. (OWNER)
- **Authorized official phone:** (208) 884-4800

## Contact information

- **Practice address:** 1001 N MERIDIAN RD, MERIDIAN, ID 83642-1610
- **Practice address phone:** (208) 884-4800
- **Practice address fax:** (208) 884-4802
- **Mailing address:** 1001 N MERIDIAN RD, MERIDIAN, ID 83642-1610
- **Mailing address phone:** (208) 884-4800
- **Mailing address fax:** (208) 884-4802

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/17/2007
- **Last updated:** 09/14/2010