Organization
TRG, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY WALLNER (MANAGER)
(503) 797-6356
Entity
Organization
Contact information
Practice address
9205 SW BARNES RD, PORTLAND, OR 97225-6603
(503) 216-4830
Mailing address
PO BOX 25180, PORTLAND, OR 97298-0180
(503) 292-9108
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500623355
—
OR
Enumeration date
05/20/2010
Last updated
03/17/2011
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