Provider Demographics
NPI:1336152271
Name:AESOP, INC.
Entity Type:Organization
Organization Name:AESOP, INC.
Other - Org Name:AESOP-CPMP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLEY
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-491-5744
Mailing Address - Street 1:4084 PENDLETON WAY
Mailing Address - Street 2:# 264
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-5224
Mailing Address - Country:US
Mailing Address - Phone:317-897-1877
Mailing Address - Fax:
Practice Address - Street 1:4084 PENDLETON WAY
Practice Address - Street 2:# 264
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-5224
Practice Address - Country:US
Practice Address - Phone:317-897-1877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026336A173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY238740OtherLICENSE #
CAC52231OtherLICENSE #
INC3409Medicare UPIN