Provider Demographics
NPI:1669403846
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:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWENZFEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-843-3802
Mailing Address - Street 1:1010 S BIRCH AVE
Mailing Address - Street 2:
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:
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:2006-07-05
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN365415282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN738745800Medicaid
MN241336Medicare Oscar/Certification