Organization
RIVERSIDE PODIATRY CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY LYNN ADSIT DPM (OWNER)
(765) 664-0107
Entity
Organization
Contact information
Practice address
1900 W KEM RD, MARION, IN 46952-1548
(765) 664-0107
(765) 664-6541
Mailing address
1900 W KEM RD, MARION, IN 46952-1548
(765) 664-0107
(765) 664-6541
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000307
IN
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000083983
BLUE CROSS BLUE SHIELD
IN
01
—
DR6511
RR MEDICARE
IN
Enumeration date
07/22/2006
Last updated
06/18/2015
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