Organization
GRAND TRAVERSE PATHOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY W FERGUSON MD (PRESIDENT)
(231) 935-6108
Entity
Organization
Contact information
Practice address
1105 6TH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-0499
Mailing address
PO BOX 9099, LONGVIEW, TX 75608-9099
(903) 663-4800
(419) 223-2726
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018175
MIDWEST HEALTH PLAN
MI
01
—
0B87602
BCBS
MI
01
—
36478
COMMUNITY CHOICE OF MI
MI
01
—
510047
PREFERRED CHOICES
MI
01
—
53481A
HEALTH ALLIANCE PLAN
MI
01
—
820
PRIORITY HEALTH
MI
01
—
CB1092
RAILROAD MEDICARE
MI
01
—
XX01516
HEALTHPLUS
MI
Enumeration date
07/25/2006
Last updated
04/15/2025
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