Healthcare Provider Details

I. General information

NPI: 1851110902
Provider Name (Legal Business Name): PAIGE LILLIAN HERBST PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FORT CARSON CO
80913-4613
US

IV. Provider business mailing address

1650 COCHRANE CIR
FORT CARSON CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-503-7387
  • Fax: 719-526-7132
Mailing address:
  • Phone: 719-503-7387
  • Fax: 719-526-7132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1102X
TaxonomyMilitary Outpatient Operational (Transportable) Component Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: