KEATON JAMES RIDER
NPI 1083369938
Military Health Care Provider - Independent Duty Medical Technicians in Cannon Afb, NM

Active since February 18, 2022
104 W D.L. INGRAM AVE, CANNON AFB, NM 88101(575) 784-2778 Get Directions Write a Review

NPPES record last updated: August 2, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 2, 2022, Feb 18, 2022 (2 updates tracked since 2022).

About Keaton James Rider NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KEATON JAMES RIDER (NPI 1083369938) is an individual independent duty medical technicians provider in Cannon Afb, New Mexico, licensed in Texas (L5ALJ4N051C00AB) and active in the NPI registry since February 2022.

NPPES Registry Identity

NPI1083369938
Entity TypeIndividualMale
Primary Taxonomy1710I1003X
Provider Legal NameKEATON JAMES RIDER
Location Address104 W D.L. INGRAM AVECannon Afb, NM 88101
Mailing Address6948 Campos Ave Unit BJber, AK 99506-3423
Sole ProprietorYes
Enumeration DateFebruary 18, 2022
Last NPPES UpdateAugust 2, 20222 updates tracked since enumeration
NPPES CertifiedJuly 21, 2022
NPI 1083369938 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Taxonomy Code1710I1003X
License Licensed in TX · L5ALJ4N051C00AB
Definition
An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians.
104 W D.L. INGRAM AVE, Cannon Afb, NM 88101

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner (Primary Care)
104 W D.L. INGRAM AVE
CANNON AFB, NM 88101
Dental Hygienist
104 W D.L. INGRAM AVE
CANNON AFB, NM 88101

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Keaton Rider's NPI number?

The NPI number for Keaton Rider is 1083369938. It was assigned to this individual provider in the NPPES registry on February 18, 2022.

Where is Keaton Rider located?

Keaton Rider practices at 104 W D.L. Ingram Ave, Cannon Afb, NM 88101. The listed phone number is (575) 784-2778.

What is Keaton Rider's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Medical Technicians, with taxonomy code 1710I1003X.

When was this NPI record last updated?

The NPPES record for Keaton Rider was last updated on August 2, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.