MEDICARE: K-VA-T FOOD STORES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356727820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K-VA-T FOOD STORES INC

Provider Business Mailing Address
First Line	:	PO BOX 1158
Second Line	:
City	:	ABINGDON
State	:	VA
Zip	:	24212-1158
Country	:	US
Telephone Number	:	276-623-5100
Fax Number	:	276-623-5440

Provider Business Practice Location Address
First Line	:	3901 DAYTON BLVD
Second Line	:
City	:	RED BANK
State	:	TN
Zip	:	37415-2715
Country	:	US
Telephone Number	:	423-877-9516
Fax Number	:	423-877-9459

Authorized Official
Title or Position	:	CHAIRMAN, PRESIDENT & CEO
Name	:	MR. STEVEN C SMITH
Credential	:
Telephone Number	:	276-623-5100

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	01/15/2026

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