Basic Information
| Provider Information | |||||||||
| NPI: | 1366597650 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRINITY KENMARE HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 697 | ||||||||
| Address2: | |||||||||
| City: | KENMARE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587460697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013854296 | ||||||||
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| Practice Location | |||||||||
| Address1: | 317 1ST AVE NW | ||||||||
| Address2: | |||||||||
| City: | KENMARE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013854296 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | KUTCH | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7018575000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 5028 | ND | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 1457938 | 05 | ND | MEDICAID |