Provider Demographics
NPI:1740359348
Name:KITTSON MEMORIAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:KITTSON MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-843-3612
Mailing Address - Street 1:1010 S BIRCH AVE
Mailing Address - Street 2:BOX 700
Mailing Address - City:HALLOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56728-4215
Mailing Address - Country:US
Mailing Address - Phone:218-843-3612
Mailing Address - Fax:
Practice Address - Street 1:1010 S BIRCH AVE
Practice Address - Street 2:BOX 700
Practice Address - City:HALLOCK
Practice Address - State:MN
Practice Address - Zip Code:56728-4215
Practice Address - Country:US
Practice Address - Phone:218-843-3612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN517325600Medicaid