NPIMap

Organization Active NPI

TRC - Four Corners Dialysis Clinics LLC

Doing business as Shiprock Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Shiprock, NM
National Provider Identifier
1487619326
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
6762 Issued in NM
Legal business name
TRC - FOUR CORNERS DIALYSIS CLINICS LLC
Doing business as
Shiprock Dialysis Center
Practice address
US Highway 491 North
Shiprock, NM 87420-2156
Phone
(505) 368-4125
Fax
(505) 368-4235
NPI assigned
Apr 20, 2006
Last updated
Apr 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Samuel T Wey
Title
VP Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 6762 NM Primary

Addresses

Primary practice location

US Highway 491 North
Shiprock, NM 87420-2156

Mailing address

5200 Virginia Way
L&C Department
Brentwood, TN 37027-7569

Other identifiers 3

IdentifierTypeStateIssuer
75514MedicaidNM
23752734MedicaidCO
485161MedicaidAZ

Other names 1

  • Shiprock Dialysis Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070214000398 NM Part A Provider - End-Stage Renal Disease Facility (ESRD) 2062322605 Practice locations: Shiprock, NM

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Chinle Dialysis8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776729600000",
    "number": "1487619326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "US HIGHWAY 491 NORTH",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "874202156",
            "telephone_number": "505-368-4125",
            "fax_number": "505-368-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRC - FOUR CORNERS DIALYSIS CLINICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NM",
            "license": "6762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "75514",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "23752734",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "485161",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shiprock Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shiprock Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shiprock, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.