Provider Demographics
NPI:1427050582
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:
Mailing Address - City:HALLOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56728-4215
Mailing Address - Country:US
Mailing Address - Phone:218-843-3662
Mailing Address - Fax:218-843-2487
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:218-843-3662
Practice Address - Fax:218-843-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327220251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN167520OtherUCARE MN
MN738745800Medicaid
MN670193100Medicaid
MN1670AKIOtherBCBS PROVIDER # HOMECARE
MN8G487KIOtherBCBS PROVIDER # PUBHEALTH
MN247103Medicare ID - Type UnspecifiedMEDICARE PROVIDER