NPIMap

Organization Active NPI

K-VA-T Food Stores, Inc.

  • Community/Retail Pharmacy
  • Jefferson City, TN
National Provider Identifier
1497818074
Registry record updated Sep 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
K-VA-T FOOD STORES, INC.
Practice address
1507 Odell Ave
Jefferson City, TN 37760-2604
Phone
(865) 471-0366
Fax
(865) 471-3612
NPI assigned
Dec 18, 2006
Last updated
Sep 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2023

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

Authorized official

Name
Mr. Steven C Smith
Title
President & Ceo
Phone
(276) 623-5100

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 4355 TN
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

1507 Odell Ave
Jefferson City, TN 37760-2604

Mailing address

PO Box 1158
Abingdon, VA 24212-1158
Phone (276) 623-5100

Other identifiers 6

IdentifierTypeStateIssuer
4439990OtherNCPDP
4143463OtherTNBCBS OF TENNESSEE
600002658OtherRAILROAD MEDICARE
1455158OtherTNTENNCARE DME
3913901OtherMEDICARE FLU SHOTS
267494OtherANTHEM BCBS

Other names 1

  • Food City Pharmacy #615 Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050302000805 TN Part B Supplier - Mass Immunization (Roster Biller Only) 8527011444 This NPI is an additional NPI on the enrollment
O20100930016846 TN DME Supplier - Pharmacy 8527011444 Practice locations: Jefferson City, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
K -VA -T Food Stores Inc1507 Odell Ave, Jefferson City, TN 37760-2604(865) 471-0366 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 assignmentParticipating since Nov 28, 2001

National Provider Directory

National Provider Directory
Tax ID family
Food City Pharmacy117 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695427200000",
    "number": "1497818074",
    "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": "1507 ODELL AVE",
            "city": "JEFFERSON CITY",
            "state": "TN",
            "postal_code": "377602604",
            "telephone_number": "865-471-0366",
            "fax_number": "865-471-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K-VA-T FOOD STORES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2023-09-23",
        "certification_date": "2023-09-23",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "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": "TN",
            "license": "4355",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4439990",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENNESSEE",
            "identifier": "4143463",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "600002658",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNCARE DME",
            "identifier": "1455158",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE FLU SHOTS",
            "identifier": "3913901",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "267494",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Food City Pharmacy #615",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Food City Pharmacy #615",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jefferson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.