NPIMap

Organization Active NPI

Kittson Memorial Hospital Association

Doing business as Kittson Memorial Clinic Karlstad

  • Rural Health Clinic/Center
  • Karlstad, MN
National Provider Identifier
1508947458
Registry record updated Jul 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KITTSON MEMORIAL HOSPITAL ASSOCIATION
Doing business as
Kittson Memorial Clinic Karlstad
Practice address
1St and Roosevelt St
Karlstad, MN 56732-0199
Phone
(218) 843-3612
NPI assigned
Oct 18, 2006
Last updated
Jul 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andrea Swenson
Title
Ceo
Phone
(218) 843-3802

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1St and Roosevelt St
Karlstad, MN 56732-0199

Mailing address

PO Box 199
Karlstad, MN 56732-0199
Phone (218) 843-3612

Other identifiers 1

IdentifierTypeStateIssuer
004938700MedicaidMN

Other names 1

  • Kittson Memorial Clinic Karlstad Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030626000007 MN Part A Provider - Rural Health Clinic 1355251315 Practice locations: Karlstad, MN
O20031208000645 MN Part B Supplier - Clinic/Group Practice 1355251315 Receives reassigned benefits from 12 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hallock, MN; Karlstad, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508947458. Details of each certification follow.

Rural health clinic certification: CCN 243427

Legal name
KITTSON MEMORIAL HOSPITAL ASSOCIATION
Doing business as
KITTSON MEMORIAL CLINIC OF KARLSTAD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 1, 2003
Last certification
Sep 10, 2015
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Jan 1, 1921 in MN
Enrollment address
205 Roosevelt W Ave
Karlstad, MN 56732-4022
Related CCNs
241336

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jana Dolores Riley Individual Corporate OfficerTreasurer Jan 1, 2019
Sandy Wilson Individual Corporate Officer Jan 1, 2018
Hugh Hunt Individual Corporate Officer Jan 1, 2019
Michael Swanson Individual Corporate Officer Jul 1, 2022
Carlene L Cole Individual Corporate Director Jun 26, 2003
W-2 Managing EmployeeHim Manager Apr 23, 1990
Stacy Diamond Individual Corporate Officer Jan 1, 2023
Roland Larter Individual Corporate Director Feb 1, 2017
Robert Jaszczak Individual Corporate OfficerChairperson Jan 1, 2018
Andrea Swenson Individual Corporate DirectorCeo Apr 1, 2023
Kenny Hultgren Individual Corporate Officer Jan 1, 2023
Janelle Craigmile Individual Corporate OfficerBoard Vice Chairperson Jan 1, 2003

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751500800000",
    "number": "1508947458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 199",
            "city": "KARLSTAD",
            "state": "MN",
            "postal_code": "567320199",
            "telephone_number": "218-843-3612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1ST AND ROOSEVELT ST",
            "city": "KARLSTAD",
            "state": "MN",
            "postal_code": "567320199",
            "telephone_number": "218-843-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KITTSON MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A",
        "authorized_official_last_name": "SWENSON",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-843-3802"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004938700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kittson Memorial Clinic Karlstad",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kittson Memorial Clinic Karlstad",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Karlstad, MN

Sources for this page

Verify at the official NPI Registry.