Organization
K-VA-T FOOD STORES, INC.
Active
Other names
Food City Pharmacy #615
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN C SMITH (PRESIDENT & CEO)
(276) 623-5100
Entity
Organization
Contact information
Practice address
1507 ODELL AVE, JEFFERSON CITY, TN 37760-2604
(865) 471-0366
(865) 471-3612
Mailing address
PO BOX 1158, ABINGDON, VA 24212-1158
(276) 623-5100
(276) 623-5440
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
4355
TN
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1455158
TENNCARE DME
TN
01
—
267494
ANTHEM BCBS
—
01
—
3913901
MEDICARE FLU SHOTS
—
01
—
4143463
BCBS OF TENNESSEE
TN
01
—
4439990
NCPDP
—
01
—
600002658
RAILROAD MEDICARE
—
Enumeration date
12/18/2006
Last updated
09/23/2023
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