Organization
TRC - FOUR CORNERS DIALYSIS CLINICS LLC
Active
Other names
Four Corners Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
801 W BROADWAY, FARMINGTON, NM 87401-5650
(505) 325-2827
(505) 326-7425
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
6763
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
485137
—
AZ
05
—
75373
—
NM
Enumeration date
04/18/2006
Last updated
12/16/2025
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