K VA T Food Stores, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

K VA T FOOD STORES, INC.

Doing business as

Food City Pharmacy #711

Practice address

1375 Broad St
Chattanooga, TN 37402-4447

Phone

(423) 508-6912

Fax

(423) 508-6913

NPI assigned

Aug 20, 2015

Last updated

Jun 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Steven C Smith

Title

Chairman, President & Ceo

Phone

(276) 623-5100

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Food City Pharmacy #711 Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1073989406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1158",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242121158",
            "telephone_number": "276-623-5100",
            "fax_number": "276-623-5440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 BROAD ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374024447",
            "telephone_number": "423-508-6912",
            "fax_number": "423-508-6913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K VA T FOOD STORES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-20",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHAIRMAN, PRESIDENT & CEO",
        "authorized_official_telephone_number": "276-623-5100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "Q021816",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Food City Pharmacy #711",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Community/Retail Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.