Provider Demographics
NPI:1376336933
Name:UTAH STATE DEPARTMENT OF CORRECTIONS
Entity type:Organization
Organization Name:UTAH STATE DEPARTMENT OF CORRECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTTISHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-346-7348
Mailing Address - Street 1:14717 S MINUTEMAN DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9549
Mailing Address - Country:US
Mailing Address - Phone:801-545-5525
Mailing Address - Fax:
Practice Address - Street 1:1480 N 8000 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-3961
Practice Address - Country:US
Practice Address - Phone:801-522-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF UTAH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health