NPIMap

Organization Active NPI

K VA T Food Stores Inc

  • Community/Retail Pharmacy
  • Kodak, TN
National Provider Identifier
1639353733
Registry record updated Jun 26, 2014
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
2946 Winfield Dunn Parkway
Kodak, TN 37764-4309
Phone
(865) 933-4676
Fax
(865) 933-4501
NPI assigned
Dec 26, 2007
Last updated
Jun 26, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2014

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
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

2946 Winfield Dunn Parkway
Kodak, TN 37764-4309

Mailing address

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

Other identifiers 5

IdentifierTypeStateIssuer
1455265OtherTNTN CROSSOVER
344784OtherANTHEM BCBS MEDIGAP
4440955OtherNCPDP
600002658OtherRAILROAD MEDICARE
4171342OtherTNBC BS OF TN

Other names 1

  • Food City Pharmacy #609 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
O20100930096782 TN DME Supplier - Pharmacy 8527011444 Practice locations: Kodak, 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
Food City Pharmacy #6092946 Winfield Dunn Pkwy, Kodak, TN 37764-4306(865) 933-4676 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

Locations

2946 Winfield Dunn Pkwy
Kodak, TN 37764
Phone (865) 465-3936

NPI Registry JSON

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403740800000",
    "number": "1639353733",
    "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": "2946 WINFIELD DUNN PARKWAY",
            "city": "KODAK",
            "state": "TN",
            "postal_code": "377644309",
            "telephone_number": "865-933-4676",
            "fax_number": "865-933-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K VA T FOOD STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-26",
        "last_updated": "2014-06-26",
        "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": 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": "TN CROSSOVER",
            "identifier": "1455265",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS MEDIGAP",
            "identifier": "344784",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4440955",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "600002658",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF TN",
            "identifier": "4171342",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Food City Pharmacy #609",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kodak, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; 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.