Provider Demographics
NPI:1447649827
Name:SENIOR HEALTH SERVICES LLC
Entity type:Organization
Organization Name:SENIOR HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:502-883-1015
Mailing Address - Street 1:2932 BRECKENRIDGE LN STE 5
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1490
Mailing Address - Country:US
Mailing Address - Phone:502-883-1015
Mailing Address - Fax:502-883-1019
Practice Address - Street 1:800 W LINCOLN TRAIL BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2671
Practice Address - Country:US
Practice Address - Phone:270-351-8661
Practice Address - Fax:270-351-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03287207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK081240Medicare PIN