MEDICARE: BAY OAKS ORTHOPAEDICS & SPORTS MEDICINE, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	J8057	TX

General Provider Information

NPI Number	:	1457576910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY OAKS ORTHOPAEDICS & SPORTS MEDICINE, P.A.

Provider Business Mailing Address
First Line	:	1051 PINELOCH DR
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77062-2742
Country	:	US
Telephone Number	:	281-286-3500
Fax Number	:	281-286-3553

Provider Business Practice Location Address
First Line	:	1051 PINELOCH DR
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77062-2742
Country	:	US
Telephone Number	:	281-286-3500
Fax Number	:	281-286-3553

Authorized Official
Title or Position	:	ORTHOPAEDIC SURGEON
Name	:	DR. ANTHONY STEPHEN MELILLO
Credential	:	M.D.
Telephone Number	:	281-286-3500

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	09/16/2010

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