Healthcare Provider Details

I. General information

NPI: 1770701849
Provider Name (Legal Business Name): KITTSON MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S BIRCH
HALLOCK MN
56728
US

IV. Provider business mailing address

1010 S BIRCH AVE
HALLOCK MN
56728-4215
US

V. Phone/Fax

Practice location:
  • Phone: 218-843-3662
  • Fax: 218-843-2487
Mailing address:
  • Phone: 218-843-3662
  • Fax: 218-843-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: ANDREA SWENSON
Title or Position: CEO
Credential: CEO
Phone: 218-843-3662