MEDICARE: GOOD SHEPHERD GERIATRIC CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TA0700X	Adult Development & Aging Psychologist
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	314000000X	Skilled Nursing Facility	170219	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	260040326	OTHER	IA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	47190	OTHER	IA	WELLMARK BLUE CROSS BLUE SHIELD OF IOWA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245214584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD GERIATRIC CENTER INC

Provider Business Mailing Address
First Line	:	302 2ND ST NE
Second Line	:	PO BOX 1707
City	:	MASON CITY
State	:	IA
Zip	:	50401-3412
Country	:	US
Telephone Number	:	641-424-1740
Fax Number	:	641-424-4260

Provider Business Practice Location Address
First Line	:	302 2ND ST NE
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-3412
Country	:	US
Telephone Number	:	641-424-1740
Fax Number	:	641-424-4260

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MICHELLE HORST
Credential	:
Telephone Number	:	641-424-1740

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	08/28/2025

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