Kittson Memorial Hospital Association
Organization Active NPI Rural Health Clinic/Center · Hallock, MN
NPI 1740359348 · NPPES record last updated Jul 3, 2025
Key facts
- NPI
- 1740359348
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- KITTSON MEMORIAL HOSPITAL ASSOCIATION
- Practice address
- 1010 S Birch Ave
Box 700
Hallock, MN 56728-4215 - Phone
- (218) 843-3612
- NPI assigned
- Nov 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Andrea Swenson
- Title
- Ceo
- Phone
- (218) 843-3612
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 6
Related certifications (CCN) 1
Practitioners 9
-
James E Surdy, M.D.
-
Julie A. J. Johnson, FNP
-
Karrah Oliver, PA-C
-
Amanda Jean Pinnock, NP-C
-
Heather Lynn Waldal, FNP-C
-
Vanessa Kay Cook, M.D.
-
Amber Dawn Deere, PMHNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D2250647 | Kittson Memorial Rural Health Clinic | Certificate of waiver | Jan 27, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Rural health clinic certification: CCN 243977
- Legal name
- KITTSON MEMORIAL HOSPITAL ASSOCIATION
- Doing business as
- KITTSON MEMORIAL HEALTHCARE CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 27, 1993
- Last certification
- Jun 11, 2015
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1922 in MN
- Enrollment address
- 1010 S Birch Ave
Hallock, MN 56728-4215 - Related CCNs
- 241336
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Sandy Wilson |
Corporate Officer | Nov 1, 2018 | |
| Hugh Hunt |
Corporate Director | Aug 1, 2019 | |
| Michael Swanson |
Corporate Director |
Aug 1, 2022 | |
| Carlene L Cole |
Operational/Managerial Control |
Apr 23, 2014 | |
| Stacy Diamond |
Corporate Director |
Feb 26, 2023 | |
| Roland Larter |
Corporate Officer | Jan 1, 2016 | |
| Andrea Swenson |
Corporate Officer |
Apr 1, 2023 | |
| Kenny Hultgren |
Corporate Director |
Feb 23, 2023 | |
| Janelle Craigmile |
Corporate Officer | Jan 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
| O20100721000385 | MN | Part a Provider - Rural Health Clinic | 1355251315 | Practice locations: Hallock, MN |
National Provider Directory
- Tax ID family
- Kittson Memorial Hospit
Locations
1010 S Birch Ave
Hallock, MN 56728
Phone (218) 843-3612
1010 S Birch Ave
#700
Hallock, MN 56728
Phone (218) 843-3612
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1010 S Birch Ave
Box 700
Hallock, MN 56728-4215
Mailing address
1010 S Birch Ave
Box 700
Hallock, MN 56728-4215
Phone (218) 843-3612
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 517325600 | Medicaid | MN |
Other names
- Kittson Memorial Clinic
Other providers in Hallock, MN
- Kittson Memorial Hospital Association
- Kittson Memorial Hospital Association
- Kittson Memorial Hospital Association
- Kittson Memorial Hospital Association
- Kittson Memorial Hospital Association
- Kittson Memorial Hospital Association
- Roland Roy Larter
- McAllen Rutz Eye Clinic PA
- Amanda Jean Pinnock
- Jalyn Robinson
All providers in Hallock, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.