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Organization
5 CODES PC
Active
Organization
5 CODES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY HEIDT (OPERATIONS MANAGER)
(509) 998-3331
Entity
Organization
Contact information
Practice address
1831 N LAKEWOOD DR STE 1, COEUR D ALENE, ID 83814-2669
(208) 215-7199
(208) 215-7199
Mailing address
1831 N LAKEWOOD DR STE 1, COEUR D ALENE, ID 83814-2669
(208) 215-7199
(208) 215-7199
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
07/06/2026
Last updated
07/06/2026
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