Healthcare Provider Details

I. General information

NPI: 1043128390
Provider Name (Legal Business Name): DRIFTLINE ANESTHESIA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 BOURNEWOOD LN
CHARLOTTE NC
28226-3260
US

IV. Provider business mailing address

4626 BOURNEWOOD LN
CHARLOTTE NC
28226-3260
US

V. Phone/Fax

Practice location:
  • Phone: 419-206-8978
  • Fax:
Mailing address:
  • Phone: 419-206-8978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD PEIFFER III
Title or Position: CEO
Credential: CRNA
Phone: 419-206-8978