# SELF

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

## Provider details

- **NPI number:** 1740655471
- **Authorized official:** MARY ELIZABETH MOENICH PA-C (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (440) 539-0929

## Contact information

- **Practice address:** 7627 KEY WEST DR, PARMA, OH 44134-6624
- **Practice address phone:** (440) 539-0929
- **Mailing address:** 7627 KEY WEST DR, PARMA, OH 44134-6624
- **Mailing address phone:** (440) 539-0929

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QU0200X | Urgent Care Clinic/Center | 004508 | OH | — |
| 261QU0200X | Urgent Care Clinic/Center | 085.005738 | IL | Yes |

## Other

- **Enumeration date:** 12/07/2015
- **Last updated:** 12/07/2015