Healthcare Provider Details

I. General information

NPI: 1053417402
Provider Name (Legal Business Name): KEYSTONE KIDNEY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 NINA WAY
WARMINSTER PA
18974-2826
US

IV. Provider business mailing address

1990 STEAM WAY STE A102
ROUND ROCK TX
78665-2233
US

V. Phone/Fax

Practice location:
  • Phone: 847-544-5880
  • Fax: 512-872-5105
Mailing address:
  • Phone: 847-544-5880
  • Fax: 512-872-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICIA SABLESAK
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 847-544-5880