Provider Demographics
NPI:1265617799
Name:SOUTHSHORE FAMILY MEDICINE, P.A.
Entity type:Organization
Organization Name:SOUTHSHORE FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:COTTINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-316-1033
Mailing Address - Street 1:2640 E LEAGUE CITY PKWY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3368
Mailing Address - Country:US
Mailing Address - Phone:281-538-8000
Mailing Address - Fax:281-538-8009
Practice Address - Street 1:400 W MEDICAL CENTER BLVD STE 215
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4227
Practice Address - Country:US
Practice Address - Phone:281-316-1033
Practice Address - Fax:281-316-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0045QHOtherBC/BS