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	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	5095	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4445397	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1477806065
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	:	2310 MCGRADY DRIVE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323
Country	:	US
Telephone Number	:	423-599-7053
Fax Number	:	423-790-0006

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

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	01/14/2025

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Directions to “K-VA-T FOOD STORES, INC ” Practice Location

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