TRC FOUR CORNERS DIALYSIS CLINICS LLC (NPI# 1639135379) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639135379 |
| Entity Type | Organization |
| Organization Name | TRC FOUR CORNERS DIALYSIS CLINICS LLC |
| Other Organization Name | KAYENTA DIALYSIS |
| Practice Address |
Highway 163 Kayenta AZ 86033-9997 |
| Mailing Address |
5200 Virginia Way L&c Dept Brentwood TN 37027-7569 |
| Practice Telephone | 9286978193 |
| Practice Fax Number | 9286978195 |
| Mailing Telephone | 6153416814 |
| Mailing Fax Number | 8002938405 |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2019-07-18 |
| Authorized Official Name | JAMES K HILGER (CHIEF ACCOUNTING OFFICER) |
| Authorized Official Telephone | 2537334500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | 953372911022 | 05 | |
| NM | 19057512 | 05 | |
| AZ | 472655 | 05 |
| Other Name | Type Code |
|---|---|
| Kayenta Dialysis | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306499405 | Trc Four Corners Dialysis Clinics LLC | Clinic/Center | 4525 Rowe Ave, Farmington, NM 87402-3013 | 2019-07-18 |
| 1083670723 | Trc Four Corners Dialysis Clinics LLC | Clinic/Center | 500 Edgewater Drive, Tuba City, AZ 86045-2905 | 2006-04-21 |
| 1184691909 | Trc Four Corners Dialysis Clinics LLC | Clinic/Center | 610 E Main St, Ste C, Cortez, CO 81321 | 2006-03-01 |
| Street Address |
HIGHWAY 163 |
| City | KAYENTA |
| State | AZ |
| Zip Code | 86033-9997 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861863342 | Edward Kobialka Jr. | Pharmacist | Highway 163, Building Ka 2010, Kayenta, AZ 86033 | 2015-10-09 |
| 1720462195 | Carole Ashley | Social Worker | Highway 163, Bldg Ka-2010, Kayenta, AZ 86033 | 2015-07-16 |
| 1710382858 | Sugar Vinnette Young | Registered Nurse | Highway 163, Kayenta Health Center Bldg Ka-2010, Kayenta, AZ 86033 | 2014-10-31 |
| 1992043798 | Christopher Leroy Anderson | Pharmacist | Highway 163, Kayenta Service Center, Kayenta, AZ 86033 | 2013-01-29 |
| 1982934618 | Sequel Tsi of Az, LLC | Clinic/Center | Highway 163, Kayenta Mobile Home Park #8, Kayenta, AZ 86033 | 2009-12-31 |
| 1467789701 | Roxanne Natalie Thomas | Social Worker | Highway 163, Building Ka-2010, Kayenta, AZ 86033 | 2009-11-06 |
| 1235303991 | Jonathan James Lewis | Social Worker | Highway 163, Kayenta Health Center, Kayenta, AZ 86033 | 2008-04-14 |
| 1659309268 | Melanie Tarutani | Optometrist | Highway 163, Kayenta, AZ 86033 | 2006-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962048306 | Pauletta A Butterfly | Social Worker | Hwy. 160 Mp 394.3, Kayenta, AZ 86033 | 2019-11-20 |
| 1871143255 | Andrea Dawn Begay | Nurse's Aide | Us Hwy 160 M.p. 394.3, Kayenta, AZ 86033 | 2019-09-17 |
| 1083264451 | Mavis Ann Bahe | Nurse's Aide | Kayenta Health Center, Us Hwy 160, Mp 394.3, Kayenta, AZ 86033 | 2019-09-17 |
| 1609420165 | Emily Ingram Nimon | Registered Nurse | Kayenta Health Center Hwy 160 M.p. 394.3, Kayenta, AZ 86033 | 2019-08-01 |
| 1700439577 | Sherri A Verdon | Registered Nurse | Hwy 160 M.p 394.3, Kayenta, AZ 86033 | 2019-07-22 |
| 1447712104 | Cynthia Kaye Robbins | Registered Nurse | Us Highway 160 Mile Post 394.3, Kayenta, AZ 86033 | 2019-04-02 |
| 1871051052 | Brian Jason Miller | Registered Nurse | Hwy 160, Mile Post 394.3, Kayenta, AZ 86033 | 2019-03-07 |
| 1265915615 | Marissa Brooke Wall | Optometrist | 394.3 Us-160, Kayenta, AZ 86033 | 2018-09-12 |
| 1467952762 | Michael Ruddy | Pharmacist | Hwy 160 1/2 Mile South of Mile Post 394.3, Kayenta, AZ 86033 | 2018-02-14 |
| 1922516319 | Xavier Kelton Nelson | Spec/Tech, Pathology | Highway 160 Mp 394.3, Kayenta Health Center, Kayenta, AZ 86033 | 2018-01-19 |
| Find all providers in zip 86033 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
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| 1811450281 | Bio Medical Applications of Arizona LLC | Clinic/Center | 450 S Gilbert Rd, Chandler, AZ 85225-2479 | 2019-04-11 |
| 1437612165 | Southwest Kidney - Davita Dialysis Partners LLC | Clinic/Center | 14620 W Encanto Blvd Ste 110, Goodyear, AZ 85395-1616 | 2019-04-10 |
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| 1437613916 | Premier Home Dialysis Services | Clinic/Center | 20118 N 67th Ave Ste 300-527, Glendale, AZ 85308-4621 | 2019-01-29 |
| 1801369186 | Bio Medical Applications of Arizona LLC | Clinic/Center | 7862 E Florentine Rd Ste 100, Prescott Valley, AZ 86314-2216 | 2019-01-09 |
| 1932688256 | Southwest Kidney Davita Dialysis Partners LLC | Clinic/Center | 926 E Mcdowell Rd Ste 100, Phoenix, AZ 85006-2503 | 2018-08-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.