Kittson Memorial Hospital Association
Organization Active NPI Rural Health Clinic/Center · Karlstad, MN
NPI 1508947458 · NPPES record last updated Jul 3, 2025
Key facts
- NPI
- 1508947458
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- KITTSON MEMORIAL HOSPITAL ASSOCIATION
- Practice address
- 1St and Roosevelt St
Karlstad, MN 56732-0199 - Phone
- (218) 843-3612
- NPI assigned
- Oct 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Andrea Swenson
- Title
- Ceo
- Phone
- (218) 843-3802
Owners & managing parties with NPI records 1
-
Jana D Riley, D.C.
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 5
Related certifications (CCN) 1
Practitioners 11
-
Julie A. J. Johnson, FNP
-
Karrah Oliver, PA-C
-
Amanda Jean Pinnock, NP-C
-
Heather Lynn Waldal, FNP-C
-
James E Surdy, M.D.
-
Vanessa Kay Cook, M.D.
-
Abbey L Anderson, FNP-C
-
Rebecca Schulz, FNP
-
Paul Raymond Anderson, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
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
- Other · Non-profit
- Incorporated
- Jan 1, 1921 in MN
- Enrollment address
- 205 Roosevelt W Ave
Karlstad, MN 56732-4022 - Related CCNs
- 241336
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Jana Dolores Riley |
Corporate Officer |
Jan 1, 2019 | |
| Sandy Wilson |
Corporate Officer | Jan 1, 2018 | |
| Hugh Hunt |
Corporate Officer | Jan 1, 2019 | |
| Michael Swanson |
Corporate Officer | Jul 1, 2022 | |
| Carlene L Cole |
Corporate Director | Jun 26, 2003 | |
| W-2 Managing Employee |
Apr 23, 1990 | ||
| Stacy Diamond |
Corporate Officer | Jan 1, 2023 | |
| Roland Larter |
Corporate Director | Feb 1, 2017 | |
| Robert Jaszczak |
Corporate Officer |
Jan 1, 2018 | |
| Andrea Swenson |
Corporate Director |
Apr 1, 2023 | |
| Kenny Hultgren |
Corporate Officer | Jan 1, 2023 | |
| Janelle Craigmile |
Corporate Officer |
Jan 1, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004938700 | Medicaid | MN |
Other names
- Kittson Memorial Clinic Karlstad
Other providers in Karlstad, MN
- Melanie Hartmann
- Ind School District #2358
- Karlstad Family Chiropractic
- Karlstad Family Chiropractic P.a.
- Karlstad Healthcare Center, Inc
- Karrah Oliver
- Jana D Riley
- Thrifty Drug Stores Inc
- Tri-County Emergency Medical Services District, Inc.
- Shania Carol Wollin
All providers in Karlstad, MN · Rural Health Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.