NPIMap

Organization Active NPI

TRC - Four Corners Dialysis Clinics LLC

Doing business as Kayenta Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Kayenta, AZ
National Provider Identifier
1639135379
Registry record updated Sep 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
TRC - FOUR CORNERS DIALYSIS CLINICS LLC
Doing business as
Kayenta Dialysis
Practice address
Highway 163 #217
Kayenta, AZ 86033-9997
Phone
(928) 697-8182
Fax
(928) 697-8195
NPI assigned
Apr 21, 2006
Last updated
Sep 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 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 Primary

Addresses

Primary practice location

Highway 163 #217
Kayenta, AZ 86033-9997

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
472655MedicaidAZ

Other names 1

  • Kayenta Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030514000056 AZ Part A Provider - End-Stage Renal Disease Facility (ESRD) 2062322605 Practice locations: Kayenta, AZ

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 1

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": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790553600000",
    "number": "1639135379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HIGHWAY 163 #217",
            "city": "KAYENTA",
            "state": "AZ",
            "postal_code": "860339997",
            "telephone_number": "928-697-8182",
            "fax_number": "928-697-8195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRC - FOUR CORNERS DIALYSIS CLINICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2026-09-28",
        "certification_date": "2026-09-28",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "472655",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kayenta Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kayenta Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kayenta, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.