NPIMap

Organization Active NPI

St Lukes - St Vincents Healthcare

Doing business as Ascension Rx 1403

  • Community/Retail Pharmacy
  • Jacksonville, FL
National Provider Identifier
1790879732
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
ST LUKES - ST VINCENTS HEALTHCARE
Doing business as
Ascension Rx 1403
Practice address
1 Shircliff Way
Ste 1734
Jacksonville, FL 32204
Phone
(904) 308-7515
Fax
(904) 308-7514
NPI assigned
Oct 3, 2006
Last updated
Sep 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Coba Susan Cornejo
Title
Chief Operating Officer
Phone
(803) 463-5837

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

1 Shircliff Way
Ste 1734
Jacksonville, FL 32204

Mailing address

1 Shircliff Way
Ste 1734
Jacksonville, FL 32204
Phone (904) 308-7515

Other identifiers 2

IdentifierTypeStateIssuer
022451100MedicaidFL
22451101MedicaidFL

Other names 1

  • Ascension Rx 1403 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20241126001642 FL Part B Supplier - Pharmacy 2668553058 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jacksonville, FL
O20250430001172 FL DME Supplier - Pharmacy 2668553058 Practice locations: Jacksonville, FL

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
St Lukes - St Vincents Healthcare1 Shircliff Way, Jacksonville, FL 32204-4748(904) 308-7515 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Dec 1, 2024

National Provider Directory

National Provider Directory
Tax ID family
St Lukes-St Vincents Healthcare5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1 Shircliff Way
Ste 1734
Jacksonville, FL 32204
Phone (904) 308-7515

12740 Atlantic Blvd
Ste 1
Jacksonville, FL 32225
Phone (904) 431-3716

2 Shircliff Way
Ste 400
Jacksonville, FL 32204
Phone (904) 308-4000

2 Shircliff Way
Ste 920
Jacksonville, FL 32204
Phone (904) 308-1380

3 Shircliff Way
Ste 527
Jacksonville, FL 32204
Phone (904) 308-6370

1545 Branan Field Rd
Ste 1
Middleburg, FL 32068
Phone (904) 450-8575

1658 St Vincents Way
Ste 100
Middleburg, FL 32068
Phone (904) 354-8200

1658 St Vincents Way
Ste 310
Middleburg, FL 32068
Phone (904) 602-4450

1895 Kingsley Ave
Ste 903
Orange Park, FL 32073
Phone (904) 276-1663

2300 Park Ave
Ste 200
Orange Park, FL 32073
Phone (904) 269-1075

2300 Park Ave
Ste 204
Orange Park, FL 32073
Phone (904) 215-2510

300 Saint Elizabeth Way
Ste 110
St Johns, FL 32259
Phone (904) 691-9100

300 Saint Elizabeth Way
Ste 140
St Johns, FL 32259
Phone (904) 691-0001

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ascension St. Vincent's SouthsideJacksonville, FL, CCN 100307 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 12, 2008
Ascension St. Vincent's SouthsideJacksonville, FL, CCN 10T307 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 12, 2008

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1790879732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SHIRCLIFF WAY",
            "address_2": "STE 1734",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32204",
            "telephone_number": "904-308-7515",
            "fax_number": "904-308-7514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SHIRCLIFF WAY",
            "address_2": "STE 1734",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32204",
            "telephone_number": "904-308-7515",
            "fax_number": "904-308-7514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES - ST VINCENTS HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2025-09-02",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "CORNEJO",
        "authorized_official_first_name": "COBA",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "803-463-5837"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022451100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "22451101",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Rx 1403",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.