NPIMap

Individual provider Active NPI

Elizabeth Marie Koury, PA-C

  • Physician Assistant
  • Wellsboro, PA
National Provider Identifier
1194006718
Registry record updated Jul 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA055089 Issued in PA
Practice address
7 Water St
Wellsboro, PA 16901-1126
Phone
(570) 724-1010
NPI assigned
Sep 9, 2011
Last updated
Jul 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA055089 PA Primary

Addresses

Primary practice location

7 Water St
Wellsboro, PA 16901-1126

Mailing address

40 W Wellsboro St
Mansfield, PA 16933-1411
Phone (570) 662-1945

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111202000415 PA Practitioner - Physician Assistant 8123293156 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

416 S Main St
Mansfield Laurel Health Center
Mansfield, PA 16933-1510
Phone (570) 662-2002

6 Riverside PLZ
Blossburg, PA 16912-1137
Phone (570) 638-2174

7 Water St
Wellsboro, PA 16901-1126

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA055089PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Penn Comprehensive Health Services CurrentSince Nov 14, 2011 Accepting new patients
North Penn Comprehensive Health Services CurrentSince Nov 14, 2011 Accepting new patients
North Penn Comprehensive Health Services Past Accepting new patients

Locations

6 Riverside Plz
Blossburg, PA 16912
Phone (570) 638-2174

40 W Wellsboro St
Mansfield, PA 16933
Phone (570) 662-1945

416 S Main St
Mansfield, PA 16933
Phone (570) 662-1900

410 Main St
Ste 102
Towanda, PA 18848
Phone (570) 266-5882

7 Water St
Wellsboro, PA 16901
Phone (570) 724-1010

Interoperability endpoints

  • Direct secure messaging: elizabeth.koury@upmcdirect.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689292800000",
    "number": "1194006718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 W WELLSBORO ST",
            "city": "MANSFIELD",
            "state": "PA",
            "postal_code": "169331411",
            "telephone_number": "570-662-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 WATER ST",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011126",
            "telephone_number": "570-724-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOURY",
        "first_name": "ELIZABETH",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-09",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA055089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellsboro, PA

Sources for this page

Verify at the official NPI Registry.