Healthcare Provider Details

I. General information

NPI: 1699038497
Provider Name (Legal Business Name): ANDRES XAVIER SAMAYOA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDRES SAMAYOA-MENDEZ M.D.

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SIVLEY RD SW STE 300
HUNTSVILLE AL
35801-5102
US

IV. Provider business mailing address

930 FRANKLIN ST SE
HUNTSVILLE AL
35801-4312
US

V. Phone/Fax

Practice location:
  • Phone: 256-536-5594
  • Fax: 256-533-3379
Mailing address:
  • Phone: 256-533-3388
  • Fax: 256-533-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT201505
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number42998
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: