Provider Demographics
NPI:1376026328
Name:AZ HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:AZ HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOHIUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-578-4016
Mailing Address - Street 1:1312 MOULTRIE CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1942
Mailing Address - Country:US
Mailing Address - Phone:224-578-4016
Mailing Address - Fax:
Practice Address - Street 1:JANE TODD CRAWFORD HOSPITAL
Practice Address - Street 2:202 MILBY STREET
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743
Practice Address - Country:US
Practice Address - Phone:270-932-4211
Practice Address - Fax:270-932-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100029970Medicaid