Active NPI
Dale Preston Henken, MD
- Pediatrics Physician
- Coos Bay, OR
National Provider Identifier
1306097555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD150386
- Practice address
- 1900 Woodland Dr
Coos Bay, OR 97420-2045 - Phone
- (541) 267-5151
- Fax
- (541) 266-4562
- NPI assigned
- Oct 7, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G41486 | CA | |
| Pediatrics Physician | 208000000X | MD150386 | OR | Primary |
Addresses
Primary practice location
1900 Woodland Dr
Coos Bay, OR 97420-2045
Mailing address
1900 Woodland Dr
Coos Bay, OR 97420-2045
Phone (541) 267-5151
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 93-0635514 | Other | OR | NBMC MAIN GROUP TAX ID FOR BILLING |
| 161133 | Other | OR | NBMC MAIN GROUP DMAP |
| 500630202 | Medicaid | OR | |
| MD150386 | Other | OR | OREON MEDICAL LICENSE |
| 1407812365 | Other | OR | NBMC MAIN GROUP NPI |
| R0000WFBTV | Other | OR | NBMC MAIN GROUP MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316995200000",
"number": "1306097555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 WOODLAND DR",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974202045",
"telephone_number": "541-267-5151",
"fax_number": "541-266-4562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 WOODLAND DR",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974202045",
"telephone_number": "541-267-5151",
"fax_number": "541-266-4562"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENKEN",
"first_name": "DALE",
"middle_name": "PRESTON",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-07",
"last_updated": "2011-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G41486",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OR",
"license": "MD150386",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NBMC MAIN GROUP TAX ID FOR BILLING",
"identifier": "93-0635514",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NBMC MAIN GROUP DMAP",
"identifier": "161133",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500630202",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREON MEDICAL LICENSE",
"identifier": "MD150386",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NBMC MAIN GROUP NPI",
"identifier": "1407812365",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NBMC MAIN GROUP MEDICARE",
"identifier": "R0000WFBTV",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coos Bay, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.