K-VA-T Food Stores, Inc.
Organization Active NPI Community/Retail Pharmacy · Trenton, GA
NPI 1912376492 · NPPES record last updated Jul 12, 2016
Key facts
- NPI
- 1912376492
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- K-VA-T FOOD STORES, INC.
- Practice address
- 112 Crimson Drive
Trenton, GA 30752 - Phone
- (706) 657-3734
- Fax
- (706) 657-3734
- NPI assigned
- Sep 15, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Steven C Smith
- Title
- Chairman, President & Ceo
- Phone
- (276) 623-5100
Other NPIs on the same Medicare enrollment 9
Corporate family (same tax ID) 8
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| K-VA-T Food Stores Inc |
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 GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160503001855 | GA | DME Supplier - Pharmacy | 8527011444 | Practice locations: Trenton, GA |
| O20160527001008 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8527011444 |
9 other NPIs on this enrollment Practice locations: Calhoun, GA; Trenton, GA; Rossville, GA; Ringgold, GA; La Fayette, GA; Dalton, GA; Chatsworth, GA; Cartersville, GA… |
National Provider Directory
- Tax ID family
- Food City Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
112 Crimson Drive
Trenton, GA 30752
Mailing address
PO Box 1158
Abingdon, VA 24212-1158
Phone (276) 623-5100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01659427 | Other | GA | RR MEDICARE FLU |
| 003168110A | Medicaid | GA |
Other names
- Food City Pharmacy #233
Other providers in Trenton, GA
- Highland Rivers Community Service Board
- Lucinda S Hill
- Anna Katharine Horne
- Idoc Holdings LLC
- Independent Physical Therapy of Georgia, LLC
- Hayley L. Keller Vice
- Mary Dee Kelly
- Shalane Marie Lamb
- Stephanie Wolfrum Lawson
- Mark Christian Liedberg
All providers in Trenton, GA · Community/Retail Pharmacy in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2016. 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.