Healthcare Provider Details

I. General information

NPI: 1114845526
Provider Name (Legal Business Name): 5 CODES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1831 N LAKEWOOD DR STE 1
COEUR D ALENE ID
83814-2669
US

IV. Provider business mailing address

1831 N LAKEWOOD DR STE 1
COEUR D ALENE ID
83814-2669
US

V. Phone/Fax

Practice location:
  • Phone: 208-215-7199
  • Fax: 208-215-7199
Mailing address:
  • Phone: 208-215-7199
  • Fax: 208-215-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STACEY HEIDT
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 509-998-3331