NPIMap

Organization Active NPI

Kittson Memorial Hospital Association

Doing business as Kittson Memorial Clinic

  • Rural Health Clinic/Center
  • Hallock, MN
National Provider Identifier
1740359348
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
Practice address
1010 S Birch Ave
Box 700
Hallock, MN 56728-4215
Phone
(218) 843-3612
NPI assigned
Nov 7, 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) 843-3612

Specialties & licenses 1

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

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 1

IdentifierTypeStateIssuer
517325600MedicaidMN

Other names 1

  • Kittson Memorial Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740359348. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Oct 1, 1922 in MN
Enrollment address
1010 S Birch Ave
Hallock, MN 56728-4215
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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2250647Kittson Memorial Rural Health Clinic1010 South Birch Ave, Hallock, MN 56728Certificate of waiverJan 27, 2028

National Provider Directory

National Provider Directory
Tax ID family
Northwestern MN HLTH CL7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1010 S Birch Ave
#700
Hallock, MN 56728
Phone (218) 843-3612

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Sandy Wilson Individual Corporate Officer Nov 1, 2018
Hugh Hunt Individual Corporate Director Aug 1, 2019
Michael Swanson Individual Corporate DirectorDirector Aug 1, 2022
Carlene L Cole Individual Operational/Managerial ControlHealth Information Manager Apr 23, 2014
Stacy Diamond Individual Corporate DirectorDirector Feb 26, 2023
Roland Larter Individual Corporate Officer Jan 1, 2016
Andrea Swenson Individual Corporate OfficerCeo Apr 1, 2023
Kenny Hultgren Individual Corporate DirectorDirector Feb 23, 2023
Janelle Craigmile Individual Corporate Officer Jan 1, 2019

Practitioners & affiliated clinicians

Practitioners 4

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": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751500800000",
    "number": "1740359348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 S BIRCH AVE",
            "address_2": "BOX 700",
            "city": "HALLOCK",
            "state": "MN",
            "postal_code": "567284215",
            "telephone_number": "218-843-3612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 S BIRCH AVE",
            "address_2": "BOX 700",
            "city": "HALLOCK",
            "state": "MN",
            "postal_code": "567284215",
            "telephone_number": "218-843-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KITTSON MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "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": "218-843-3612"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "517325600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kittson Memorial Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kittson Memorial Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hallock, MN

Sources for this page

Verify at the official NPI Registry.