=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598637514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LTK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2025
-----------------------------------------------------
Last Update Date | 09/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3846 GEORGE II HWY UNIT A
-----------------------------------------------------
City | SOUTHPORT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28461-8214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-845-2846
-----------------------------------------------------
Fax | 910-636-1058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3846 GEORGE II HWY UNIT A
-----------------------------------------------------
City | SOUTHPORT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28461-8214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-845-2846
-----------------------------------------------------
Fax | 910-636-1058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LAURIE GRANT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-845-2846
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------