K VA T Food Stores Inc
Organization Active NPI Community/Retail Pharmacy · Elizabethton, TN
NPI 1316964778 · NPPES record last updated Sep 25, 2007
Key facts
- NPI
- 1316964778
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- K VA T FOOD STORES INC
- Practice address
- 920 Broad St
Village Shopping Ctr
Elizabethton, TN 37643-2315 - Phone
- (423) 542-4925
- Fax
- (423) 542-6744
- NPI assigned
- Jul 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Steven C Smith
- Title
- President & Ceo
- Phone
- (276) 623-5100
Corporate family (same tax ID) 24
Practitioners 3
-
Michael Stein, PHARMACIST
-
Ellen Michelle Roberson Whitehead, PHARM.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Food City Pharmacy #631 |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Nebulizer … | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050302000805 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 8527011444 | This NPI is an additional NPI on the enrollment |
| O20100930094571 | TN | DME Supplier - Pharmacy | 8527011444 | Practice locations: Elizabethton, TN |
National Provider Directory
- Tax ID family
- Food City Pharmacy
Locations
920 Broad St
Elizabethton, TN 37643
Phone (423) 542-4925
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 4068 | TN | |
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
920 Broad St
Village Shopping Ctr
Elizabethton, TN 37643-2315
Mailing address
PO Box 1158
Abingdon, VA 24212-1158
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4090831 | Other | TN | BCBS OF TENNESSEE |
| 4437629 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 146179 | Other | ANTHEM BCBS | |
| 3913901 | Other | MEDICARE FLU SHOTS | |
| 4437629 | Other | NCPDP | |
| 1454650 | Other | TN | TENNCARE DME |
Other names
- FOOD CITY PHARMACY
Other providers in Elizabethton, TN
- Jonathan Baker Enterprises, LLC
- Brooke Nicole Jones-Cannon
- Jessica Nichole Jones
- Deepak Joshi
- Tabitha R Justice
- Haley Keylon
- Jean Ann Kimbrel
- Rebekah N King
- Celesta V Kirk
- James Kirkpatrick III
All providers in Elizabethton, TN · Community/Retail Pharmacy in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.