In Khorramabad, the spatial distribution of urban services does not correspond to the distribution of population or residents’ actual patterns of access to services, and this mismatch contributes to spatial inequality among neighborhoods. Despite previous studies on inequalities in the distribution of urban services in Iran, the simultaneous integration of network-based accessibility, population–service coverage mismatch, the spatial structure of deprivation, and the prioritization of interventions at the neighborhood scale has received limited attention. This study aims to assess these dimensions and translate the results into spatial intervention priorities in Khorramabad. First, network-based service accessibility areas were calculated using thresholds of 1,000 m for healthcare services and 500 m for educational and cultural services. The Service Population Mismatch Index (SPMI) was then calculated for each neighborhood, and spatial patterns of advantage and deprivation were identified using Local Moran’s I (LISA). Subsequently, the relative importance of services was determined using the Analytic Hierarchy Process (AHP), and the results were integrated into a spatial multi-criteria decision analysis model. The results revealed substantial mismatches between population and service coverage across Khorramabad’s neighborhoods. The integrated results placed neighborhoods 13, 12, 10, and 22 among the highest intervention priorities. The findings indicate that jointly assessing the intensity of population–service mismatch and its spatial structure can provide a more precise basis for place-based urban service policy-making in medium-sized Iranian cities.