Provider W9 Form
Please email and attach the W9 Form to controller@motivhealth.com with the following information.
Company Name:
TaxID:
Street Address:
City:
State:
Zipcode:
Is this a remittance address?:
Contact Name:
Email:
Phone:
MotivHealth Insurance Company
844-234-4472 | MEDICAL
385-247-1030 | PHARMACY
385-308-4400 | EMPLOYERS
385-308-4410 | MOTIVNET – Contract
10421 S Jordan Gateway, Ste. 300
South Jordan, UT 84095
Copyright © 2024 MotivHealth Insurance Company. All Rights Reserved.