Organization
TRC - FOUR CORNERS DIALYSIS CLINICS LLC
Active
Other names
Tuba City Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
500 EDGEWATER DRIVE, TUBA CITY, AZ 86045-2905
(928) 283-4525
(928) 283-4801
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
472663
—
AZ
05
—
953372911019
—
UT
Enumeration date
04/21/2006
Last updated
09/23/2024
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