Provider Demographics
NPI:1649226671
Name:TRINITY KENMARE HOSPITAL
Entity Type:Organization
Organization Name:TRINITY KENMARE HOSPITAL
Other - Org Name:KENMARE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-857-5000
Mailing Address - Street 1:PO BOX 5020
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5020
Mailing Address - Country:US
Mailing Address - Phone:701-857-5118
Mailing Address - Fax:701-857-5031
Practice Address - Street 1:307 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:KENMARE
Practice Address - State:ND
Practice Address - Zip Code:58746-7104
Practice Address - Country:US
Practice Address - Phone:701-385-4283
Practice Address - Fax:701-385-4282
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-25
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND05148Medicaid
ND13047Medicaid
ND1460650Medicaid
ND1460641Medicaid