Provider Demographics
NPI:1518984962
Name:K -VA -T FOOD STORES INC
Entity Type:Organization
Organization Name:K -VA -T FOOD STORES INC
Other - Org Name:FOOD CITY PHARMACY #428
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-623-5100
Mailing Address - Street 1:PO BOX 1158
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-1158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 NORTH 11TH STREET
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:606-248-7689
Practice Address - Fax:606-242-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
KY06758333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00339233OtherRAILROAD MEDICARE
1827320OtherOTHER ID NUMBER-COMMERCIAL NUMBER
KY90004813OtherMEDICAID DME
VA009111387OtherMEDICAID DME
KY435579OtherANTHEM BCBS
KY1827320OtherNCPDP
TN4033467OtherBCBS
KY54003272Medicaid
VA008515981OtherMEDICAID
KYFLU0297OtherMEDICARE FLU
KY435579OtherANTHEM BCBS