Medical Avenue Internal Medicine PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

0101054605 Issued in VA

Legal business name

MEDICAL AVENUE INTERNAL MEDICINE PC

Practice address

1920 Medical Ave
Ste F
Harrisonburg, VA 22801-8016

Phone

(540) 908-3095

Fax

(540) 908-3085

NPI assigned

Mar 30, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Ilija Steven Rakaric

Title

Director / Incorporator

Phone

(540) 908-3095

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1427673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429488000000",
    "number": "1780079558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 MEDICAL AVE",
            "address_2": "STE F",
            "city": "HARRISONBURG",
            "state": "VA",
            "postal_code": "228018016",
            "telephone_number": "540-908-3095",
            "fax_number": "540-908-3085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 MEDICAL AVE",
            "address_2": "STE F",
            "city": "HARRISONBURG",
            "state": "VA",
            "postal_code": "228018016",
            "telephone_number": "540-908-3095",
            "fax_number": "540-908-3085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL AVENUE INTERNAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-30",
        "last_updated": "2015-04-20",
        "status": "A",
        "authorized_official_last_name": "RAKARIC",
        "authorized_official_first_name": "ILIJA",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "DIRECTOR / INCORPORATOR",
        "authorized_official_telephone_number": "540-908-3095",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "VA",
            "license": "0101054605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1184734154",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMA HEALTH",
            "identifier": "21467",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006023169",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "211236",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Harrisonburg, VA
• Providers in Harrisonburg, VA by specialty
• Primary Care Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.