Provider Demographics
NPI:1114107133
Name:CARL STEPHEN HIGH MD
Entity Type:Organization
Organization Name:CARL STEPHEN HIGH MD
Other - Org Name:C. S. HIGH MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BODKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-636-9242
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:909 GORMAN AVE.
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-0390
Mailing Address - Country:US
Mailing Address - Phone:304-636-9242
Mailing Address - Fax:304-636-8152
Practice Address - Street 1:909 GORMAN AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-4109
Practice Address - Country:US
Practice Address - Phone:304-636-9242
Practice Address - Fax:304-636-8152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0056511001Medicaid
31894OtherSTATE LICENSE
AH9529364OtherDEA
WV0056511001Medicaid
WVA72188Medicare UPIN