TRC - FOUR CORNERS DIALYSIS CLINICS LLC NPI 1083670723

NPI Information

TRC - FOUR CORNERS DIALYSIS CLINICS LLC is an end-stage renal disease (esrd) treatment clinic center in Tuba City, AZ. TRC - FOUR CORNERS DIALYSIS CLINICS LLC NPI is 1083670723. The provider is registered as an organization entity type.
The provider Is Doing Business As Tuba City Dialysis.

The provider's business location address is:

500 EDGEWATER DRIVE
TUBA CITY, AZ
ZIP 86045-905
Phone: (928) 283-4525
Fax: (928) 283-4801

The provider's authorized official is Samuel T Wey .
The authorized official title is Sr Director Licensure&certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 03D0713447 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/21/2006 and was last updated on 10/16/2023.

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:

Other Identifiers

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

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