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TRC - FOUR CORNERS DIALYSIS CLINICS LLC NPI 1063477727


NPI Information

NPI: 1063477727
Provider Name: TRC - FOUR CORNERS DIALYSIS CLINICS LLC

Doing Business As: FOUR CORNERS DIALYSIS CENTER

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 32D0713388

Address:
801 W BROADWAY
FARMINGTON, NM
ZIP 87401
Phone: (505) 325-2827
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TRC - FOUR CORNERS DIALYSIS CLINICS LLC is an end-stage renal disease (esrd) treatment clinic center in Farmington, NM. TRC - FOUR CORNERS DIALYSIS CLINICS LLC NPI is 1063477727. The provider is registered as an organization entity type.
The provider Is Doing Business As Four Corners Dialysis Center.

The provider's business location address is:

801 W BROADWAY
FARMINGTON, NM
ZIP 87401-650
Phone: (505) 325-2827
Fax: (505) 326-7425

The provider's authorized official is John D Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The CLIA number assigned to this NPI record is 32D0713388 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/18/2006 and was last updated on 12/8/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment6763NEW MEXICOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
175373MEDICAIDNEW MEXICO
2485137MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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