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HEADWATERS HEALTH PC
NPI 1821976903
Family Medicine in Fosston, MN

Active since August 26, 2025CLIA 24D2332057 · Waiver
111 2ND ST NE, FOSSTON, MN 56542(218) 435-1111 Get Directions Write a Review

NPPES record last updated: November 11, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Headwaters Health Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HEADWATERS HEALTH PC (NPI 1821976903) is a healthcare organization registered as a family medicine in Fosston, Minnesota and active in the NPI registry since August 2025. The organization holds a CLIA Waiver certificate valid through October 13, 2027, maintains a secondary practice location in Fosston, and lists Cheryl White, Md, as its authorized official.

NPPES Registry Identity

NPI1821976903
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameHEADWATERS HEALTH PC
Location Address111 2ND ST NEFosston, MN 56542-1301
Mailing Address111 2nd St NeFosston, MN 56542-1301 · (218) 435-1111
Phone(218) 435-1111
Organization SubpartNo
Authorized OfficialCheryl WhiteMd · (218) 435-1111
Enumeration DateAugust 26, 2025
Last NPPES UpdateNovember 11, 2025
NPPES CertifiedNovember 11, 2025
✔ NPI 1821976903 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
111 2ND ST NE, Fosston, MN 56542
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Secondary Practice Location 1

Location 1104 Kaiser Ave NFosston, MN 56542-1225 · Phone (218) 435-1111

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D2332057

Headwaters Health · Fosston, MN
Active · expires Oct 13, 2027
CLIA Number24D2332057
Laboratory TypePhysician Office
Certificate Effective DateOctober 14, 2025
Certificate Expiration DateOctober 13, 2027
Laboratory DirectorDarren D. Swanson
Laboratory Phone(218) 435-1111
Laboratory LocationHeadwaters Health111 2nd St NE, Fosston, MN 56542
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRADLEY W NEUJAHR OD PA
Optometrist
111 2ND ST NE
FOSSTON, MN 56542
Polk County (218) 435-1010
MS. MAIJA L DUPPONG
Nurse Practitioner (Family)
111 2ND ST NE
FOSSTON, MN 56542
Polk County (218) 435-1111
SHEILA K TEIKEN APRN,CNP
Nurse Practitioner (Family)
111 2ND ST NE
FOSSTON, MN 56542
Polk County (218) 435-1111
SANFORD HEALTH OF NORTHERN MINNESOTA
Optometrist
111 2ND ST NE
FOSSTON, MN 56542
Polk County (218) 435-1010
MRS. NICOLE MARIE KIESOW PA-C
Physician Assistant
111 2ND ST NE
FOSSTON, MN 56542
Polk County (218) 435-1111
DR. CHERYL WHITE MD
Family Medicine
111 2ND ST NE
FOSSTON, MN 56542
Polk County (218) 435-1111
BRYAN MIKAEL JOHNSON PA-C
Physician Assistant
111 2ND ST NE
FOSSTON, MN 56542
Polk County (218) 435-1111
CARLIE J PLETSCHETT APRN, CNP
Nurse Practitioner (Family)
111 2ND ST NE
FOSSTON, MN 56542
Polk County (218) 435-1111

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Headwaters Health PC's NPI number?

The NPI number for Headwaters Health PC is 1821976903. It was assigned to this organization in the NPPES registry on August 26, 2025.

Where is Headwaters Health PC located?

Headwaters Health PC is located at 111 2nd St NE, Fosston, MN 56542. The listed phone number is (218) 435-1111.

What is Headwaters Health PC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Headwaters Health PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2332057) is associated with this NPI, valid through October 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Headwaters Health PC was last updated on November 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.