NPIMap

Organization Active NPI

TRC - Four Corners Dialysis Clinics LLC

Doing business as Hopi Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Polacca, AZ
National Provider Identifier
1700842432
Registry record updated Jun 3, 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
Hopi Dialysis Center
Practice address
Hwy 264
Mile Marker 388
Polacca, AZ 86042-0964
Phone
(928) 605-4021
Fax
(928) 605-4022
NPI assigned
Apr 21, 2006
Last updated
Jun 3, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 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

Hwy 264
Mile Marker 388
Polacca, AZ 86042-0964

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
631152MedicaidAZ

Other names 1

  • Hopi Dialysis Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070227000709 AZ Part A Provider - End-Stage Renal Disease Facility (ESRD) 2062322605 Practice locations: Polacca, 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.

  • Total Renal Care Inc

    dba TRC Children's Dialysis Center

    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Chicago, IL
    • NPI 1396704508

    Member Of

    NPD member

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": "1780444800000",
    "number": "1700842432",
    "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": "HWY 264",
            "address_2": "MILE MARKER 388",
            "city": "POLACCA",
            "state": "AZ",
            "postal_code": "860420964",
            "telephone_number": "928-605-4021",
            "fax_number": "928-605-4022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRC - FOUR CORNERS DIALYSIS CLINICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "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": "631152",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hopi Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hopi Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Polacca, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.