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| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | Obrien, Edward | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| NPI | 1972546521 | [sources] | |||
| Sector | Physician/Emergency Medicine | [sources] | |||
| Status | not available | [sources] | |||
| Address | 149 Drinkwater Blvd, Bay St. Louis, MS 39520 | [sources] | |||
| Last change | Last processed | First seen | |||
Service providers who have been terminated for cause from Mississippi's Medicaid program.
United States of America · Mississippi Division of Medicaid
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States of America | Mississippi Division of Medicaid | - | |||