DAFTAR JEJARING TRAUMA CENTER DAN ... - BPJS … cent… · daftar jejaring trauma center dan...

DAFTAR JEJARING TRAUMA CENTER DAN FASILITAS KERJASAMABPJS KETENAGAKERJAAN

Periode : 01/01/2016 s/d 31/12/2016

Halaman : Tanggal Cetak : Waktu Cetak :

1 / 15116-05-201607:59:01

MA11222I DAFTAR JEJARING TRAUMA CENTER DAN FASILITAS KERJASAMA BPJS KETENAGAKERJAAN SM0480

KANTOR CABANG : 001- KANTOR CABANG TERNATE

NO KODE PROVIDER NAMA PROVIDER ALAMAT KODEPOS TELEPON PIMPINAN

IKS

NO IKS TIPE IKS AWAL IKS AKHIR IKS

1 1400000000043 DR. TUTHANURANII NACHRAWY, M. KES

JL. PAHLAWAN REVOLUSI DR.TUTHANURANI NACHRAWY

PER/004/032016 RS.TRAUMA CENTRE

31/03/2016 31/12/2018

2 06574 RUMAH SAKIT ISLAM BINA WARGA TERNATE JLN.PEMUDA NO.131 KOTA TERNATE 3121623 YAYASAN ISLAM BINA

WARGA PER/002/012016 RS.TRAUMA CENTRE 14/03/2016 31/12/2016

3 1500000000035 RUMAH SAKIT MEDIKA HARIFALM KEL KOTA BARU KOTA TERNATE DR.AZIS MANAF SP.PD PER/001/012016 RS.TRAUMA

CENTRE 22/02/2016 31/12/2016

4 08016 RUMAH SAKIT UMUM DAERAH LABUHA JL. RAYA LABUHA BABANG 21118 HJ. AISA BADARUNI

S.KM, M.KES PER/003/012016 RS.TRAUMA CENTRE 14/03/2016 31/12/2016

KANTOR CABANG : 003- KOTA TUAL


IKS


1 7-3193917369RSUD KAREL SATSUITUBUN LANGGUR

JL. MERDEKA RAYA NO. 03 OHOIJANG LANGGUR

9761121612/21613

DR. K. NOTANUBUN, M. KES

199/631/RSUD/KS/V/2016

RS.TRAUMA CENTRE

09/05/2016 06/04/2018

KANTOR CABANG : 100- KANTOR CABANG SORONG


IKS


1 1500000000503BALAI LATIHAN KERJA INDUSTRI (BLKI) SORONG JL BASUKI RAHMAT KM 9.5 KOTA SORONG 322549

YULIANTI MATANDUNG,S.SOS,MM PER/008/042016

RS.TRAUMA CENTRE 25/04/2016 31/03/2017


Periode : 01/01/2016 s/d 31/12/2016


2 / 15116-05-201607:59:01



IKS


2 1400000000012 KLINIK MAJU BERSAMA (KLINIK-TC)

JL BASUKI RAHMAT KM 11 (DEPAN BATALION) DR LIDIA KURNIAWAN PER/003/032016 RS.TRAUMA

CENTRE 01/03/2016 28/02/2017

3 1400000000555 KLINIK MAJU BERSAMA II AIMAS (KTC) JL WORTEL AIMAS UNIT 2 KAB SORONG 13351490 DR. GINDAR SITEPU PER/044/122015 RS.TRAUMA

CENTRE 05/01/2016 30/11/2016

4 04658 RS MUTIARA JL MALEO NO 2 SORONG 0951327433

DR HJ PAHIMAH/ISKANDAR


05/01/2016 31/12/2016

5 1400000000567 RSAL DR AZHAR ZAHIR MANOKWARI (RSTC)

JLN SERMA SUWANDI MANOKWARI 211758 MABES TNI AL PER/006/022016 RS.TRAUMA CENTRE

07/03/2016 31/01/2017

6 1400000000022 RSAL DR OETOYO (RS TC) JLN JEND AHMAD YANI PER/002/032016 RS.TRAUMA CENTRE 27/04/2016 28/02/2017

7 1400000000539 RSUD KAB FAK-FAK (RSTC) JL. JENDRAL SUDIRMAN KAB FAK-FAK 44671705 PER/02/122015RS.TRAUMA CENTRE 12/05/2016 30/11/2016

8 1400000000408 RSUD KAB RAJA AMPAT (RSTC)

JL DISTRIK WAISAI 44717931 PER/043/112015 RS.TRAUMA CENTRE

01/02/2016 31/10/2016

9 1400000000034 RSUD KAB SORONG (RSTC) JL KESEHATAN NO 36 321763 PER/004/042016 RS.TRAUMA CENTRE

08/04/2016 31/03/2017

10 1400000000457 RSUD MANOKWARI (RSTC) JL BHAYANGKARA NO 1 MANOKWARI 44110391 PER/010/112014RS.TRAUMA CENTRE 07/03/2016 31/10/2015

11 1400000000457 RSUD MANOKWARI (RSTC) JL BHAYANGKARA NO 1 MANOKWARI 44110391 PER/007/112015RS.TRAUMA CENTRE 07/03/2016 31/10/2016

12 02442 RSUD SORONG JL YOS SUDARSO SORONG 321580 PER/004/042016RS.TRAUMA CENTRE

01/04/2016 31/03/2017

KANTOR CABANG : 101- KANTOR CABANG JAYAPURA


Periode : 01/01/2016 s/d 31/12/2016


3 / 15116-05-201607:59:01



IKS


1 1500000000457 KLINIK PRATAMA BUNDA HATI KUDUS JL. RAYA MANDALA NO. 26 MERAUKE 44603533 KLINIK PRATAMA

BUNDA HATI KUDUS PER/03/042016 RS.TRAUMA CENTRE 13/04/2016 31/12/2017

2 1500000000524 RS BUNDA PENGHARAPAN MERAUKE JL. ANGKASA I KELAPA LIMA MERAUKE

RS BUNDA PENGHARAPAN MERAUKE

PER/02/042016 RS.TRAUMA CENTRE 13/04/2016 31/12/2017

3 1500000000081 RS MARTHEN INDEY JL. DIPONEGORO NO. 27 GURABESI RSMI JAYAPURA PER/18/122015 RS.TRAUMA CENTRE

14/01/2016 31/12/2016

4 1400000000716 RSAL DR. SOEDIBJO SARDADI

JL. AMPHIBI NO. 1 HAMADI 522958 RSAL DR. SOEDIBJO SARDADI


14/01/2016 31/12/2016

KANTOR CABANG : 102- KANTOR CABANG MIMIKA


IKS


1 1400000000460 KLINIK MAHAFIDIN MEDICAL CARE (MMC)

JLN BUDI UTOMO NO. 50 IWAN ANWAR SH PER/05/052016 RS.TRAUMA CENTRE

09/05/2016 31/12/2016

2 1500000000345RUMAH SAKIT UMUM DAERAH (RSUD) MIMIKA JLN YOS SUDARSO NAWARIPI 99910

0901-3125200 RSUD MIMIKA PER/04/042016

RS.TRAUMA CENTRE 01/05/2016 31/12/2016

KANTOR CABANG : A00- KANTOR CABANG LHOKSEUMAWE


IKS


1 08469 KLINIK LHOKSEUMAWE HUSADA

JL. MERDEKA BARAT NO. 12 F, DESA KUTA BLANG KEC. BANDA SAKTI KOTA LHOKSEUMAWE

081396697999

DR. HJ. KIKIE INDRIATY PER/04/032016 RS.TRAUMA CENTRE

24/03/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


4 / 15116-05-201607:59:01



IKS


2 1500000000229 KLINIK VINCA ROSEA LHOKSEUMAWE

JL. DARUSSALAM NO. 36 GAMPONG JAWA BARU AZHARI PER/06/052016 RS.TRAUMA

CENTRE 02/05/2016 31/12/2016

3 1500000000225 KLINIK VINCA ROSEA TAKENGON

JLN. ABDUL WAHAB KP. SIMPANG EMPAT KECAMATAN BEBESAN AZHARI PER/07/052016 RS.TRAUMA

CENTRE 02/05/2016 31/12/2016

4 1500000000630 PUSKESMAS PAYA BAKONG JL TGK SYIK PAYA BAKONG CEUMPEUDAKKAB ACEH UTARA

DR. WAHYUDI HIDAYAT PER/10/052016 RS.TRAUMA CENTRE

10/05/2016 31/12/2016

5 1500000000127 RUMAH SAKIT AVICENNA BIREUEN

JL KUALA RAJA NO.1 GAMPONG LHOK AWE TEUNGOH KECAMATAN KOTA JUANG

22887 DR.FAISAL,SP.OG PER/02/022016 RS.TRAUMA CENTRE

24/02/2016 31/12/2016

6 7-2060022073 RUMAH SAKIT PMI ACEH UTARA

JALAN SAMUDERA GAMPONG KAMPUNG JAWA KEC BANDA SAKTI 24352 DR FERIANTO PER/01/022016 RS.TRAUMA

CENTRE 17/02/2016 31/12/2016

7 1400000000410RUMAH SAKIT PT. ARUN NGL

JL. PLAJU KOMPLEK PT. ARUN NGL GP. BATUPHAT BARAT KEC. MUARA SATU 653165

DR. SYAHRUDDIN IBRAHIM PER/27/102015

RS.TRAUMA CENTRE 18/02/2016 31/12/2016

8 1400000000322 RUMAH SAKIT UMUM BUNDA LHOKSEUMAWE

JL. DARUSSALAM NO. 16 KECAMATAN BANDA SAKTI

46924 DR. HANAFIAH HASAN, SP.OG


18/02/2016 31/12/2016

9 1400000000691 RUMAH SAKIT UMUM BUNGA MELATI

JL SAMUDERA BARU NO. 3 KEUDE ACEH KEC. BANDA SAKTI

44821 DR.TAUFIQ A.R PER/03/022016 RS.TRAUMA CENTRE

26/02/2016 31/12/2016

KANTOR CABANG : A01- KANTOR CABANG BANDA ACEH


IKS


1 1500000000167 BLUD RS IBU DAN ANAK ACEH

JL. PROF. A. MAJID IBRAHIM I NO. 3 KEL. PUNGE JURONG KEC MEURAXA

637433 PEMERINTAH ACEH PER/20/022016 RS.TRAUMA CENTRE

03/03/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


5 / 15116-05-201607:59:01



IKS


2 1400000000569 CEMPAKA LIMAJLN. TGK. H. M. DAUD BEUREUEH NO.78 A BEURAWE KEC.KUTA ALAM KOTA BANDA ACEH

33345 HJ. KARTINI.N.I PER/38/122015 RS.TRAUMA CENTRE 13/01/2016 31/12/2016

3 1500000000056 KLINIK AA MEDICAL JL SIGLI -KB. TANJONG NO.1 GP.PANTE KEC. SIMPANG TIGA KAB.PIDIE HJ. AGUSMIATI, S.SI.T PER/14/022016 RS.TRAUMA

CENTRE 10/02/2016 31/12/2016

4 1400000000566 KLINIK ATHARI JL. RUKOH UTAMA NO.21 GP. RUKOH KEC. SYIAH KUALA -KOTA BANDA ACEH

DR. TEUKU MUHAMMAD YUS


12/01/2016 31/12/2016

5 1400000000670 KLINIK BUNDA JL.BANDA ACEH-MEDAN NO.1 GAMPONG BARO JAMAN KEC. MUTIARA

ITA MUTIA PER/17/022016 RS.TRAUMA CENTRE

22/02/2016 31/12/2016

6 1500000000122 KLINIK CAHAYA BUNDA JL. KEBUN RAJA GP. IE MASEN KEC. ULEE KARENG BATA KOTA BANDA ACEH DR.BUDI PERMANA PER/08/022016 RS.TRAUMA

CENTRE 10/02/2016 31/12/2016

7 1500000000055KLINIK KELUARGA ASMAULHUSNA GAMPONG ULEE GLE KEC BANDAR DUA SAIFUL BAHRI IDRIS PER/04/012016

RS.TRAUMA CENTRE 27/01/2016 31/12/2016

8 1500000000153 KLINIK KIMIA FARMA JL. PERDAGANGAN NO. 1 KOTA SIGLI KEC. KOTA SIGLI KAB. PIDIE

21536 M. BAGUS ANDREAS TAUFANI, S.FARM, APT


10/02/2016 31/12/2016

9 1500000000019 KLINIK LATIFAHJL. SOEKARNO -HATTA N0.04 DSN. MELATI GP. GAROT KEC. DARUL IMARAH KAB. ACEH BESAR

SISKA ARSYAD, S.KED PER/19/022016 RS.TRAUMA CENTRE

02/03/2016 31/12/2016

10 1500000001919 KLINIK MITRA MEDISTRAJL. RESIDEN DANUBROTO GP. LAMLAGANGKEC. BANDA RAYA 23111

AZIZURRAHMAN, SKM,MM PER/10/022016

RS.TRAUMA CENTRE 10/02/2016 31/12/2016

11 7-1676350253KLINIK RANUP PEUNAWA MEDIKA

JL SOEKARNO HATTA GP LAMPEUNEURUT UJONG BLANG KEC DARUL IMARAH KAB. ACEH BESAR

23352 72303666 CAPT. FADLI, SE, M.MAR PER/05/012016RS.TRAUMA CENTRE 01/02/2016 31/12/2016

12 1400000000677 KLINIK RAWAT INAP MINAJL.LAKSAMANA MALAHAYATI KM.7 GP.BAET KEC.BAITUSSALAM KAB. ACEH BESAR

DR. RAHMI PER/13/022016RS.TRAUMA CENTRE

10/02/2016 31/12/2016

13 1400000000673 KLINIK SIWAH MEDIKA CENTER

JL.T.P. POLEM NO. 168-174 GP.PEUNANYONG, KEC. KUTA ALAM KOTABANDA ACEH

LYDIA SEPTA DESIYANA,M.SI, APT


10/02/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


6 / 15116-05-201607:59:01



IKS


14 1500000000242 KLINIK UMMI AISYAH JL. PERDAGANGAN GAMPONG KUTA BARAT KOTA SABANG MINALTIWATI, AMD.KEB PER/18/022016 RS.TRAUMA

CENTRE 27/02/2016 31/12/2016

15 1400000000191 RS CITRA HUSADA SIGLI JL. PROF MAJID IBRAHIM LAMPEUDEU BAROH KOTA SIGLI KABUPATEN PIDIE 96707970 DR JULIANA SP AK PER/28/092015 RS.TRAUMA

CENTRE 12/01/2016 01/09/2016

16 1400000000073 RS HARAPAN BUNDA JL T UMAR NO 181-185 GP SEUTUI 48114 DR. ZAINAL BAKRI SPOG PER/07/022016 RS.TRAUMA CENTRE

25/02/2016 31/12/2016

17 1400000000073 RS HARAPAN BUNDA JL T UMAR NO 181-185 GP SEUTUI 48114 DR. ZAINAL BAKRI SPOG PER/15/032015 RS.TRAUMA CENTRE

15/02/2016 24/02/2016

18 1400000000692 RSUD KABUPATEN PIDIE JAYA

JL. BANDA - ACEH KM. 158, MEUREUDU KABUPATEN PIDIE JAYA PER/09/022016 RS.TRAUMA

CENTRE 10/02/2016 31/12/2016

19 7-2017798742 RSUD ZAINOEL ABIDINJL. TGK H.M DAUD BEUREUEUH NO 108 BANDA ACEH 23121 60668923

DR. FACHRUL JAMAL, SP.AN. KIC PER/16/022016

RS.TRAUMA CENTRE 16/02/2016 31/12/2016

20 7-2017798742 RSUD ZAINOEL ABIDIN JL. TGK H.M DAUD BEUREUEUH NO 108 BANDA ACEH

23121 60668923 DR. FACHRUL JAMAL, SP.AN. KIC


15/02/2016 31/12/2018

21 1500000000093 RUMAH SAKIT IBNU SINA JL B. ACEH-MEDAN KM 25,5 DESA SINYEU KEC INDRAPURI

085238105999

DIANA PURWANI PER/36//12/2015 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

22 1400000000194RUMAH SAKIT TGK FAKINAH

JL. JEND SUDIRMAN NO. 17, KOTA BANDA ACEH 44114 YAYASAN TGK FAKINAH PER/34/122015

RS.TRAUMA CENTRE 12/01/2016 01/01/2017

23 1400000000570 RUMAH SAKIT U'BUDIYAH 7555750 PT. CAISARIO ROYAL PRATAMA PER/35/122015

RS.TRAUMA CENTRE 12/01/2016 31/12/2016

24 1500000000302RUMAH SAKIT UMUM BULAN SABIT MERAH

JL. SULTAN MALIKUL SALEH NO.17 GP. LAMLAGANG , KEC. BANDA RAYA

HERI RISWANDI PER/21/032016RS.TRAUMA CENTRE

03/03/2016 31/12/2016

25 1500000000302 RUMAH SAKIT UMUM BULAN SABIT MERAH

JL. SULTAN MALIKUL SALEH NO.17 GP. LAMLAGANG , KEC. BANDA RAYA

HERI RISWANDI PER/21/022016 RS.TRAUMA CENTRE

03/03/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


7 / 15116-05-201607:59:01



IKS


26 1500000000166 RUMKIIT BHAYANGKARA JL. CUT NYAK DHIEN NO. 1 KEL. LAMTEUMEN 41470 KEPOLISIAN REPUBLIK

INDONESIA PER/22/032016 RS.TRAUMA CENTRE 07/04/2016 31/12/2016

27 7-2832361743 RUMKIT TK II ISKANDAR MUDA BANDA ACEH

JL T. HAMZAH BENDAHARA NO 1 KOTA BANDA ACEH 23121 KEENTRIAN

PERTAHANAN RI PER/24/042016 RS.TRAUMA CENTRE 07/04/2016 31/12/2016

KANTOR CABANG : A02- KANTOR CABANG LANGSA


IKS


1 1400000000546DR. SYARIFAH RINA MARLINA

JL. H AGUSSALIM NO. 20 KAMPUNG BLANG LANGSA KOTA 20354

DR. SYARIFAH RINA MARLINA PER/02/012016

RS.TRAUMA CENTRE 21/01/2016 31/12/2016

2 7-2520482973 KLINIK BAITU SSYIFA DSN KUTA DESA KEUDE PEUREULAK KEC PEUREULAK ACEH TIMUR

24454 ZULFIKAR, S.KEP PER/824/032016 RS.TRAUMA CENTRE

15/03/2016 31/12/2016

3 1400000000552 KLINIK BINA HUSADA JL. T. CHIK DITIRO NO. 3 GAMPONG PAYA BUJOK TUNONG LANGSA BARO

0853361873663

DR H SYAFRIRUDDIN, MM


27/01/2016 31/12/2016

4 1500000000037PUSKESMAS BANDAR PUSAKA KECAMATAN BANDAR PUSAKA

085363910858 SYAMSUDDIN, SKM PER/04/012016

RS.TRAUMA CENTRE 21/01/2016 31/12/2017

5 1500000000398PUSKESMAS LANGSA BARAT

JL. PROF A.MAJID IBRAHIM DESA BIREM PUNTONG KEC LANGSA BARAT 23093

AYU ARTLINTA, SKM, M.KES PER/21/012016

RS.TRAUMA CENTRE 10/03/2016 31/12/2016

6 1500000000396 PUSKESMAS LANGSA BAROJL. LILAWANGSA NO. 01 PAYA BUJOK TUNONG KEC LANGSA BARO

SAFRITA, SKM PER/22/012016RS.TRAUMA CENTRE

10/03/2016 31/12/2016

7 1500000000522 PUSKESMAS LANGSA KOTA JLN H. AGUS SALIM NO. 10 SUNGAI PAUH KEC LANGSA BARAT KOTA LANGSA

69222267 DR. T CHIK M. IQBAL F PER/23/012016 RS.TRAUMA CENTRE

10/03/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


8 / 15116-05-201607:59:01



IKS


8 1500000000395 PUSKESMAS LANGSA LAMA JL PENDIDIKAN DS MEURANDEH DAYA KEC LANGSA LAMA

NS. EDI SYAHPUTRA, S.KEP PER/24/012016 RS.TRAUMA

CENTRE 10/03/2016 31/12/2016

9 1500000000397 PUSKESMAS LANGSA TIMUR JL. MEDAN-BANDA ACEH KM. 7 GP ALUE PINEUNG KEC LANGSA TIMUR DR. MAHLIDAYANTI PER/25/012016 RS.TRAUMA

CENTRE 07/03/2016 31/12/2016

10 1500000000040 PUSKESMAS SEKERAK KECAMATAN SEKERAK 082168103036

DR. ABDUL GAFUR PER/03/012016 RS.TRAUMA CENTRE

21/01/2016 31/12/2017

11 1400000000340 RSU CUT MEUTIA JL GARUDA NOMOR 1 KEBUN BARU KECAMATAN LANGSA BARO

23071 IR EDDY PURNOMO PER/01/012016 RS.TRAUMA CENTRE

13/01/2016 31/12/2016

12 1400000000340 RSU CUT MEUTIA JL GARUDA NOMOR 1 KEBUN BARU KECAMATAN LANGSA BARO 23071 IR EDDY PURNOMO PER/25/122015 RS.TRAUMA

CENTRE 18/01/2016 31/12/2016

13 1400000000675 RSU CUT NYAK DHIEN JL. T.M. BACHRUM NO 1 KOTA LANGSA 22228 DR YUSUF, MM PER/01/012016RS.TRAUMA CENTRE 18/01/2016 31/12/2016

14 06730 RSUD ACEH TAMIANG JL. KESEHATAN KECAMATAN KARANG BARU

31791 DR. ZUHEINI, M.KES PER/20/012016 RS.TRAUMA CENTRE

14/03/2016 31/12/2016

15 7-2502904553 RSUD ACEH TAMIANG JL KESEHATAN KEC KARANG BARU 24476PEMERINTAH KABUPATEN ACEH TAMIANG

PER/20/01/012016

RS.TRAUMA CENTRE

14/03/2016 31/12/2016

16 1500000000034 RSUD KOTA LANGSAJALAN JEND. AHMAD YANI NO 1 KOTA LANGSA 22051 DR. HERMAN I PER/18/012016

RS.TRAUMA CENTRE 27/01/2016 31/12/2016

17 1400000000674 RUMAH SAKIT UMUM UMMIJL PROF A.MAJID IBRAHIM DUSUN SATRIA RT 02 SUNGAI PAUH KECAMATAN LANGSA BARAT

22886DR. SAID MUHAMMAD FACHRIANSYAH PER/19/012016

RS.TRAUMA CENTRE 15/02/2016 15/02/2017

18 1400000000674 RUMAH SAKIT UMUM UMMIJL PROF A.MAJID IBRAHIM DUSUN SATRIA RT 02 SUNGAI PAUH KECAMATAN LANGSA BARAT

22886DR. SAID MUHAMMAD FACHRIANSYAH

PER/19/012016RS.TRAUMA CENTRE

16/02/2016 31/12/2016

KANTOR CABANG : A03- KANTOR CABANG MEULABOH


Periode : 01/01/2016 s/d 31/12/2016


9 / 15116-05-201607:59:01



IKS


1 1400000000612 KLINIK ANANDA FAMILY JL. CUT MEUTIA NO.34 MEULABOH 23611 DR. MARHABAN PER/08/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

2 1400000000610 KLINIK CEMPAKA LIMA MEULABOH JL. SWADAYA NO.39F-H MEULABOH 23611 AMIR HIDAYAT, ST PER/07/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

3 1400000000613 KLINIK GRAHA UMMI JL. IMAM BONJOL NO. 27-28 SEUNEUBOK MEULABOH

DERI DARMAWAN, S.PI PER/12/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

4 1400000000611 KLINIK JEUMPA MEDICA JL. GAJA MADA NO.40 MEULABOH DR. MUTIA DARMAWAN PER/13/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

5 1500000000012 PUSKESMAS ALUE BILIE JL. ERWIN IBRAHIM, KEC. DARUL MAKMUR 23662 AJA PUTRI PER/03/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

6 1500000000002 PUSKESMAS ALUE RAMBOTDESA ALUE RAMBOT, KEC. DARUL MAKMUR 23662 DR, CHAIDIR PER/20/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

7 1500000000013 PUSKESMAS BEUTONG LHOK SEUMOT, KEC.BEUTONG 23672 HJ. NURLIMPAH PER/10/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

8 1500000000004 PUSKESMAS BEUTONG ATEUH

DESA KRUENG CUT 23672 MUHAMMAD DAUD, SKM PER/39/122015 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

9 1500000000010 PUSKESMAS COT KUTAJL. NASIONAL MBO-JEURAM, KEC. SEUNAGAN 23671 NEVI HASNITA, SKM PER/09/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

10 1400000000631PUSKESMAS COT SEUMEREUNG ACEH BARAT DS. COT SEUMEUREUNG, KEC. SAMATIGA 23652 DR. SUSANTI PER/21/122015

RS.TRAUMA CENTRE 08/01/2016 31/12/2016

11 1400000000630PUSKESMAS DRIEN RAMPAK ACEH BARAT

JL. MEULABOH - BANDA ACEH, KEC. ARONGAN LAMBALEK

23652 MUHAMMAD NASIR,SKM PER/31/122015RS.TRAUMA CENTRE

08/01/2016 31/12/2016

12 1500000000008 PUSKESMAS JEURAM JL. KESEHATAN NO.2, KEC. SEUNAGAN 23671 NURZAINI PER/33/122015 RS.TRAUMA CENTRE

08/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


10 / 15116-05-201607:59:01



IKS


13 1400000000646 PUSKESMAS JOHAN PAHLAWAN ACEH BARAT

JL. TGK DIRUNDENG MEULABOH, KEC. JOHAN PAHLAWAN 23615 DR. ANDI LIDIAWATI PER/22/122015 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

14 1400000000615 PUSKESMAS KAJEUNG ACEH BARAT DS. KAJEUNG, KEC. SUNGAI MAS 23681 ZULHAMDI ,AMK PER/27/122015 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

15 1500000000005 PUSKESMAS KUALA TADU DS. KUALA TADU, KEC. TADU RAYA 23661 DARMANSYAH,S.ST PER/18/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

16 1400000000629 PUSKESMAS LAYUNG ACEH BARAT

JL. SUAK TIMAH KUALA BHEE KM 12, KEC. BUBON

23652 SALMAN RUSLI, SKM.,M.EPID


08/01/2016 31/12/2016

17 1500000000003 PUSKESMAS LUENG KEUBEU JAGAT DESA LUENG KEUBEU JAGAT 23662 DEWI SARTIKA, AMK PER/19/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

18 1400000000621PUSKESMAS MEUREUBO ACEH BARAT

JL. NASIONAL DS. UJUNG TANJUNG, KEC. MEUREUBO 23615 DR. DEPI ARISANDI AJI PER/23/122015

RS.TRAUMA CENTRE 08/01/2016 31/12/2016

19 1400000000616 PUSKESMAS MEUTULANG ACEH BARAT

JL. MEULABOH MEUTULANG, KEC. PANTON REU

23681 HASANUDDIN D, SE PER/26/122015 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

20 1500000000006 PUSKESMAS PADANG PANJANG

PADANG PANYANG, KEC. KUALA PESISIR 23661 INTAN MALA, A.MD.KEB PER/05/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

21 1500000000011PUSKESMAS PADANG RUBEK DS. PADANG RUBEK, KEC. KUALA PESISIR 23661 DR. ZURRIATY SAVITRI PER/04/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

22 1400000000617PUSKESMAS PANTE CEUREUMEN

DS. PANTE CEUREUMEN, KEC. PANTE CEUREUMEN 23681 MUHAMMAD AMIN, SE PER/25/122015

RS.TRAUMA CENTRE 08/01/2016 31/12/2016

23 1400000000618PUSKESMAS PEUREUMUE ACEH BARAT

JL. MEULABOH TUTUL, KEC. KAWAY XVI 23681 NILA TRISNA HD, AMK PER/24/122015RS.TRAUMA CENTRE

08/01/2016 31/12/2016

24 1400000000623 PUSKESMAS PIR BATEE PUTEH ACEH BARAT

DS. PASI MALL, KEC. WOYLA BARAT 23682 CUT ELI YUSRA PER/28/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


11 / 15116-05-201607:59:01



IKS


25 1400000000623 PUSKESMAS PIR BATEE PUTEH ACEH BARAT DS. PASI MALL, KEC. WOYLA BARAT 23682 CUT ELI YUSRA PER/32/122015 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

26 1500000000007 PUSKESMAS SIMPANG JAYA JL. MBO-TPK TUAN, KEC. TADU RAYA 23661 SITI ROMLAH PER/34/12215 RS.TRAUMA CENTRE 08/01/2016 31/12/2016

27 1400000000648 PUSKESMAS SUAK RIBEE ACEH BARAT

JL. KUTA PAYA SUAK RIBEE MEULABOH, KEC. JOHAN PAHLAWAN

23615 DR. SITI HAWANI PER/28/122015 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

28 1500000000001 PUSKESMAS SUKA MULIA JL. SEUNEUAM, KEC. DARUL MAKMUR 23662 JAMAL SUNGAEDI, SKM PER/37/122015 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

29 1500000000016 PUSKESMAS TANGKEH DS. TANGKEH, KEC. WOYLA TIMUR 23682 ADNEN AR, AMK PER/35/122015 RS.TRAUMA CENTRE 08/01/2016 31/12/2016

30 1500000000009PUSKESMAS UJONG FATIHAH DS. BLANG MUKO, KEC. KUALA 23661 CUT NIH PER/38/122015

RS.TRAUMA CENTRE 08/01/2016 31/12/2016

31 1500000000014 PUSKESMAS UTEUN PULO DS. BLANG PANYANG, KEC. SEUNANGAN TIMUR

23671 HJ. YUSNIDAR PER/36/122015 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

32 1400000000624 PUSKESMAS WOYLA ACEH BARAT

DS. KUALA BHEE, KEC. WOYLA 23654 YESWARDI, SKM PER/29/122015 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

33 1500000000246RSU SWASTA HARAPAN SEHAT MEULABOH

JL. SISINGAMANGARAJA DESA GAMPA KEC. JOHAN PAHLAWAN KAB. ACEH BARAT

23615 DR. MURDIATI M. KES PER/40/022016RS.TRAUMA CENTRE 03/03/2016 31/12/2016

34 1500000000245 RSUD ACEH SINGKIL JL. RIMO-SINGKIL KM.8 ACEH SINGKIL PEMDA ACEH SINGKIL PER/17/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

35 1500000000136RSUD DR H YULIDDIN AWAY

JL T. BEN MAHMUD NO 86 A, TAPAKTUAN ACEH SELATAN, ACEH

323615 PEMKAB ACEH SELATAN PER/14/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

36 1500000000123 RSUD KOTA SUBULUSSALAM

JALAN SUBUSSALAM RUNDING KM.5 DUSUN RAHMAH KEC. SIMPANG KIRI KOTASUBUSSALAM

62731700 PEMKOT SUBULUSSALAM


01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


12 / 15116-05-201607:59:01



IKS


37 1400000000602 RSUD TEUKU UMAR JLN. GUNONG ALI LR. PMI NO.1 CALANG KEC. KRUENG SABEE 23654 2210322 DR. SUZANNA OCTIVA,

SP.KJ PER/06/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

38 1500000000015 RSUD TEUNGKU PEUKAN BLANG PIDIE,ACEH BARAT DAYA 92522 DARUSMAN, M.KES (MMR) PER/11/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

39 1400000000614 RUMAH SAKIT TINGKAT IV IM 07.02 MEULABOH

JL. MERAH PUTIH GAMPONG SUAK INDRAPURI KEC. JOHAN PAHLAWAN

KAPTEM CKM DR. TEGUH ISMANTO,SP.AN


01/01/2016 31/12/2016

KANTOR CABANG : B00- KANTOR CABANG MEDAN KOTA


IKS


1 1400000000127 BP HARAPAN BUNDA JL. BRIGJEND ZEIN HAMID NO 39 TITI KUNING

7852636 NETTY BARITA, SE PER/01/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

2 1400000000127 BP HARAPAN BUNDA JL. BRIGJEND ZEIN HAMID NO 39 TITI KUNING

7852636 NETTY BARITA, SE PER/13/122015 RS.TRAUMA CENTRE

05/01/2016 31/12/2016

3 1500000000065 BP HARAPAN BUNDA 1 JL BALAI DESA NO 7 MEDAN POLONIA 6504129 NETTY BARITA,SE PER/07/122015RS.TRAUMA CENTRE 05/01/2016 31/12/2016

4 1500000000066 BP HARAPAN BUNDA 3 JL BRIGJEN KATAMSO NO 440 B NETTY BARITA SE PER/11/122015RS.TRAUMA CENTRE 05/01/2016 31/12/2016

5 1500000000201 BP KURNIA JL BINJAI KM 8.8 NO 11 KP LALANG MEDAN 850915 TAN ERFI PER/18/022016RS.TRAUMA CENTRE

18/02/2016 17/02/2017

6 1500000000201 BP KURNIA JL BINJAI KM 8.8 NO 11 KP LALANG MEDAN 850915 TAN ERFI PER/20/022016 RS.TRAUMA CENTRE

22/02/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


13 / 15116-05-201607:59:01



IKS


7 1500000000199 KLINIK ADISMA HUSADA DARUSSALAM JL DARUSSALAM NO 5A 4153169 DR H SAYID BUDHI PER/16/022016 RS.TRAUMA

CENTRE 17/02/2016 31/01/2017

8 1500000000198 KLINIK ADISMA HUSADA TEMBUNG

JL BESAR MEDAN BATANG KUIS DSN XI TEMBUNG 7383103 DR SAYID BUDHI PER/17/022016 RS.TRAUMA

CENTRE 17/02/2016 31/01/2017

9 1500000000196 KLINIK AKSARA JL AKSARA NO 120 MEDAN 97374384 TEGUH SUHARTO, SE PER/23/022016 RS.TRAUMA CENTRE

24/02/2016 31/12/2016

10 1500000000206 KLINIK AVIATI 1 JL JAMIN GINTING NO 15 P BULAN MEDAN BARU

6103683 DRG AMETA PRIMASARI TARIGAN


18/02/2016 31/01/2017

11 1500000000207 KLINIK AVIATI 3 JL JAMIN GINTING KM 8.5 KOMP DELTA NO 5 MEDAN TUNTUNGAN 3436450 DRG AMETA PRIMASARI

TARIGAN PER/21/022016 RS.TRAUMA CENTRE 22/02/2016 31/12/2016

12 1500000000203KLINIK AZIZZI GATOT SUBROTO JL JEND GATOT SUBROTO NO 333 MEDAN 4155528 DRS H RAZALI ROHIMUN PER/26/022016

RS.TRAUMA CENTRE 24/02/2016 31/12/2016

13 1500000000202 KLINIK AZIZZI SUMARSONO JL KAPT SUMARSONO NO 74 MEDAN 80030330 DR RIYADH IKHSAN PER/25/022016 RS.TRAUMA CENTRE

24/02/2016 31/12/2016

14 1500000000194 KLINIK BERSAMA JL JAMIN GINTING NO 502 P BULAN MEDAN 68272131 SAMPE REZEKI, SE PER/24/022016 RS.TRAUMA CENTRE

24/02/2016 31/12/2016

15 1400000000126 KLINIK CITRA MEDIKA JALAN SISINGAMANGARAJA NO 7 KM 4,5 7863134 DR YUDHA PRAYOGI PER/02/122015RS.TRAUMA CENTRE 07/01/2016 31/12/2016

16 1500000000195KLINIK GRIYA MEDICAL CENTER JL KAPTEN MUSLIM NO 43B 97374384 TEGUH SUHARTO,SE PER/22/022016

RS.TRAUMA CENTRE 22/02/2016 31/12/2016

17 1500000000189 KLINIK MADANI JL. BESAR NAMORAMBE TITI KUNING 7032626 DR. H DEPI MASRI PER/12/122015RS.TRAUMA CENTRE

07/01/2016 31/12/2016

18 1500000001611 KLINIK MILLENIUM JL KAPTEN MUSLIM NO 58C 63792195 SRI REZEKI SE PER/27/022016 RS.TRAUMA CENTRE

01/03/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


14 / 15116-05-201607:59:01



IKS


19 1500000000197 KLINIK SENYUM JAYA ABADI JL SETIABUDI NO 117 LINK V TG SARI 8219006 DRG ERITA FLORA

MANURUNG PER/28/022016 RS.TRAUMA CENTRE 26/02/2016 31/12/2016

20 7-2460143493 MURNI TEGUH MEMORIAL HOSPITAL JL JAWA NO 2 MEDAN 20231 80501888 PT MURNI SADAR PER/33/022016 RS.TRAUMA

CENTRE 08/03/2016 31/12/2016

21 1500000000191 RS ADVENT MEDAN JL GATOT SUBROTO KM 4 MEDAN 4524875 YAYASAN RS ADVENT MEDAN


26/02/2016 31/12/2016

22 1500000000190 RS BHAYANGKARA MEDAN JL.KH WAHID HASYIM NO 1 MEDAN 8215990 POLDA SUMUT PER/18/022015 RS.TRAUMA CENTRE

01/03/2016 31/12/2016

23 1500000000077 RS ESTOMIHI JL SISINGAMANGARAJA NO 235 7861771 DR. M SAMOSIR, SP.PD PER/09/122015 RS.TRAUMA CENTRE 07/01/2016 31/12/2016

24 1400000000129 RS ISLAM MALAHAYATI JL. PANGERAN DIPONEGORO NO 2-4 4518766 YAY RS MALAHAYATI PER/03/122015RS.TRAUMA CENTRE 07/01/2016 31/12/2016

25 1500000000208 RS MARTHA FRISKA MULTATULI

JL MULTATULI KOMP MULTATULI INDAH NO 1

4149666 PT KARYA UTAMA SEHAT SEJAHTERA


26/02/2016 31/12/2016

26 1500000000537 RS ROYAL PRIMA JL AYAHANDA NO 68 A 88813182 YAYASAN PERG TINGGI PRIMA INDONESIA


13/04/2016 31/12/2016

27 7-1446503984RS SILOAM DHIRGA SURYA MEDAN JL IMAM BONJOL NO 6 MEDAN 20111 88881900

PT GRAMARI PRIMA NUSA PER/15/012016

RS.TRAUMA CENTRE 18/01/2016 31/12/2016

28 1500000000089 RSU BINA KASIH JL JEND TB SIMATUPANG NO 148 SUNGGAL 8475111YAYASAN BINA KASIH ABADI PER/06/122015

RS.TRAUMA CENTRE 07/01/2016 31/12/2016

29 1500000000091 RSU HERNA MEDAN JL MOJOPAHIT NO 118A MEDAN 4510766YAY TD PARDEDE FOUNDATION


07/01/2016 31/12/2016

30 1500000000624 RSU MATERNA JL TEUKU UMAR NO 11 MEDAN 4514222 PT RUMAH SAKIT MATERNA


25/04/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


15 / 15116-05-201607:59:01



IKS


31 1400000000124 RSU MITRA SEJATI JL. AH NASUTION NO. 7 P. MASYHUR MEDAN 7875967 YAY. MITRA SEJATI PER/04/122015 RS.TRAUMA

CENTRE 07/01/2016 31/12/2016

32 1500000000090 RSU PROF DR BOLONI JL MONGONSIDI NO 11 MEDAN 4512687 YAY PROF DR BOLONI MARPAUNG PER/10/122015 RS.TRAUMA

CENTRE 07/01/2016 31/12/2016

33 1500000000092 RSU SARI MUTIARA JL KAPTEN MUSLIM NO 79 MEDAN 8451812 YAY SARI MUTIARA MEDAN


07/01/2016 31/12/2016

34 1500000000200 RSU VINA ESTETICA JL SULTAN ISKANDAR MUDA NO 119 4147646 YAYASAN VINA ESTETICA


01/03/2016 31/12/2016

35 7-1375319217 RUMAH SAKIT SETIABUDI JL MESJID NO 3 TANJUNG REJO MEDAN 20122 DR OTMAN SIREGAR SPOT PER/14/012016 RS.TRAUMA

CENTRE 11/01/2016 31/12/2016

KANTOR CABANG : B01- KANTOR CABANG PEMATANGSIANTAR


IKS


1 1400000000051 BPS SERASI JL. JEND. A. YANI NO. 179K 28756 TAN ERFIPER/34/TC/012016

RS.TRAUMA CENTRE 13/01/2016 31/12/2016

2 1500000000249 KLINIK AINON JL.MEDAN KM 4.5 NO.44 6205667 PAUL PARULIAN PURBA PER/40/012016RS.TRAUMA CENTRE 15/04/2016 28/02/2017

3 1500000000291 KLINIK KASIHHUTA II BENDO NAGORI DUSUN ULU KEC. UJUNG PADANG KABUPAETN SIMALUNGUN

72908220DR. SEVEN APRI H SAMOSIR


10/05/2016 28/02/2017


72908220 DR. SEVEN APRI H SAMOSIR


11/05/2016 31/12/2017


Periode : 01/01/2016 s/d 31/12/2016


16 / 15116-05-201607:59:01



IKS



72908220 DR. SEVEN APRI H SAMOSIR PER/42/052016 RS.TRAUMA

CENTRE 11/05/2016 31/12/2016

6 1500000000148 KLINIK KELUARGA JL MEDAN NO.18 KM 4 28951 IR.AGUSTINUS SIANIPAR PER/43/052016 RS.TRAUMA CENTRE 10/05/2016 31/12/2016

7 1500000000148 KLINIK KELUARGA JL MEDAN NO.18 KM 4 28951 IR.AGUSTINUS SIANIPAR PER/42/062016 RS.TRAUMA CENTRE

10/05/2016 31/01/2017

8 1500000000148 KLINIK KELUARGA JL MEDAN NO.18 KM 4 28951 IR.AGUSTINUS SIANIPAR PER/42/052016 RS.TRAUMA CENTRE

10/05/2016 31/12/2017

9 1400000000553 KLINIK MURNI JL MELANTHON SIREGAR NO.206 6204978 APRIMO MP SIBARANI PER/35/TC/012016

RS.TRAUMA CENTRE 13/01/2016 31/12/2016

10 1400000000527 KLINIK PANDU JL. SM. RAJA NO. 627 PERDAGANGAN ANTONIUSPER/36/TC/012016

RS.TRAUMA CENTRE 13/01/2016 31/12/2016

11 1500000000237 KLINIK PUTERI KEMBAR DALIL TANI NO.40 62164746 HERDIANA GULTOM PER/43/052016 RS.TRAUMA CENTRE

10/05/2016 28/02/2017

12 1500000000237 KLINIK PUTERI KEMBAR DALIL TANI NO.40 62164746 HERDIANA GULTOM PER/43/052016 RS.TRAUMA CENTRE

11/05/2016 31/12/2017

13 1500000000237 KLINIK PUTERI KEMBAR DALIL TANI NO.40 62164746 HERDIANA GULTOM PER/44/052016RS.TRAUMA CENTRE 10/05/2016 31/12/2016

14 1400000000534 KLINIK PUTRIHUTA II NAGORI BAJA DOLOK KEC TANAH JAWA 76137512 SETI HARTATI AM.KEB

PER/38/TC/012016

RS.TRAUMA CENTRE 13/01/2016 31/12/2016

15 1400000000544 KLINIK PUTRIJL SISINGAMANGARAJA NO.20 KEL PARAPAT KEC GIRSANG SIPANGAN BOLON

6474965DR.AMRAN SITUMORANG

PER/37/TC/012016

RS.TRAUMA CENTRE

13/01/2016 31/12/2016

16 1500000000236 KLINIK RIDHO JALAN SISINGAMANGARAJA NAGORI BALIMBINGAN KECAMATAN TANAH

64530224 DR. MENTI SIBURIAN PER/44/052016 RS.TRAUMA CENTRE

10/05/2016 28/02/2017


Periode : 01/01/2016 s/d 31/12/2016


17 / 15116-05-201607:59:01



IKS


17 1500000000236 KLINIK RIDHO JALAN SISINGAMANGARAJA NAGORI BALIMBINGAN KECAMATAN TANAH 64530224 DR. MENTI SIBURIAN PER/44/052016 RS.TRAUMA

CENTRE 11/05/2016 31/12/2017

18 1500000000236 KLINIK RIDHO JALAN SISINGAMANGARAJA NAGORI BALIMBINGAN KECAMATAN TANAH 64530224 DR. MENTI SIBURIAN PER/45/052016 RS.TRAUMA

CENTRE 10/05/2016 31/12/2016

19 1400000000050 KLINIK SIMA HUSADA JL. KERTAS CETAK NO. 2A 60004795ANDRE CHRISTIAN PARSAORAN SIMATUPANG

PER/39/TC/012016

RS.TRAUMA CENTRE

13/01/2016 31/12/2016

20 1500000000103 KLINIK SUMBER SEHAT JALAN KAPTEN TANDEAN BLOK D 8 6574736 DR.IRENE HARTONO PER/46/2016 RS.TRAUMA CENTRE

10/05/2016 31/12/2016

21 1500000000103 KLINIK SUMBER SEHAT JALAN KAPTEN TANDEAN BLOK D 8 6574736 DR.IRENE HARTONO PER/45/052016 RS.TRAUMA CENTRE 11/05/2016 31/12/2017

22 1500000000103 KLINIK SUMBER SEHAT JALAN KAPTEN TANDEAN BLOK D 8 6574736 DR.IRENE HARTONO PER/45/052016RS.TRAUMA CENTRE 10/05/2016 31/01/2017

23 1500000000182 KLINIK VITA MEDISTRA JL.PATTIMURA NO.11 KEC SIANTAR TIMUR 64731970 DR.JUNETA ZEBUA PER/46/052016 RS.TRAUMA CENTRE

10/05/2016 31/01/2017

24 1400000000535 RSUD PERDAGANGAN JL.RAJAMIN PURBA ,SH PERDAGANGAN 70324734 RSUD PERDAGANGAN PER/29/TC/012016

RS.TRAUMA CENTRE

13/01/2016 31/12/2016

25 1400000000676 RSUD PORSEAJL. RAJA SIPAKKO NAPITUPULU KEC. PORSEA 61245547

PEMERINTAH KAB. TOBASAMOSIR

PER/30/TC/012016

RS.TRAUMA CENTRE 13/01/2016 31/12/2016

26 1400000000350 RSUD TUAN RONDAHAIMKOMP PEMKAB SIMALUNGUN PEMATANG RAYA 331170

RSUD TUAN RONDAHAIM

PER/31/TC/012016

RS.TRAUMA CENTRE 13/01/2016 31/12/2016

27 1400000000289 RUMAH SAKIT TENTARA JL. GUNUNG SIMANUK MANUK NO. 6 434171 RUMAH SAKIT TENTARAPER/28/TC/012016

RS.TRAUMA CENTRE

13/01/2016 31/12/2016

28 1400000000545 RUMAH SAKIT UMUM DAERAH PARAPAT

JL.KOL TPR SINAGA KEC.GIRSANG SIPANGAN BOLON

62054053 RSUD PARAPAT PER/32/TC/012016

RS.TRAUMA CENTRE

13/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


18 / 15116-05-201607:59:01



IKS


29 1400000000343 RUMAH SAKIT UMUM HKBPBALIGE JL GEREJA NO.17 BALIGE 21043 RSU HKBP BALIGE PER/33/TC/0120

16RS.TRAUMA CENTRE 13/01/2016 31/12/2016

KANTOR CABANG : B02- KANTOR CABANG KISARAN


IKS


1 1400000000608 BPS SARTIKA JL. BESAR NEGERI LAMA KECAMATAN BILAH HILIR KABUPATEN LABUHAN BATU

081264339055 MURSYID DALIMUNTE PER/29/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

2 1500000000057 BPS VITA SERASIDUSUN I DESA PETATAL KEC TALAWI KAB BATUBARA 61311291 HAMZAH PER/29/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

3 1400000000109 KLINIK AMANAH JL. SEI SILAU TIMUR KEC. BUNTU PANE 7352111 DR. NURHIMSYAH JUNEDI NASUTION


01/01/2016 31/12/2016

4 1400000000109 KLINIK AMANAH JL. SEI SILAU TIMUR KEC. BUNTU PANE 7352111 DR. NURHIMSYAH JUNEDI NASUTION


01/12/2016 29/12/2016

5 1400000000606 KLINIK AULIADUSUN III DESA SEI SUKA DERAS (KEBUN KOPI) KEC. SEI SUKA KAB. BATUBARA

085297350468 RITA ADELINA PER/29/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

6 1400000000609 KLINIK CENTRAL MEDIKAJL. ACCESS ROAD INALUM DESA PAKAM RAYA KECAMATAN MEDANG DERAS KABUPATEN BATU BARA

082368310000 ZULKARNAEN PER/29/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

7 1400000000607 KLINIK DEWI SARTIKAJL. BEDAGAI NO. 129 KOTAPINANG KECAMATAN KOTA PINANG KABUPATEN LABUHAN BATU SELATAN

081264339055

MURSYID DALIMUNTE PER/29/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

8 1400000000728 KLINIK ESTOMIHI

JL. PERINTIS NO. 18 SIMPANG KAWAT DUSUN I KELURAHAN HESSA PERLOMPONGAN KECAMATAN AIR BATU KABUPATEN ASAHAN

08126286145

DR PATAR MT PANJAITAN


01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


19 / 15116-05-201607:59:01



IKS


9 1400000000714 KLINIK KESUMA BANGSAJL. LINTAS SUMATERA NO. 9 DUSUN I DESARAHUNING KECAMATAN RAHUNING KABUPATEN ASAHAN

085261585929 DRG ZANIYAR PER/30/12/2015 RS.TRAUMA

CENTRE 01/12/2016 31/12/2016

10 1400000000714 KLINIK KESUMA BANGSAJL. LINTAS SUMATERA NO. 9 DUSUN I DESARAHUNING KECAMATAN RAHUNING KABUPATEN ASAHAN

085261585929 DRG ZANIYAR PER/29/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

11 1400000000727 KLINIK MITRA SEHAT JL. KARTINI NO. 195 KECAMATAN KOTA KISARAN BARAT KABUPATEN ASAHAN

08126286145



01/01/2016 31/12/2016

12 1400000000718 KLINIK RAKYATJL. SM RAJA UJUNG BANDAR KECAMATAN RANTAU SELATAN KABUPATEN LABUHAN BATU

08126286145



01/01/2016 31/12/2016

13 1500000000129 MITRA KLINIK DR H AHYAR RANGKUTI

DUSUN 1C DESA KAMPUNG PAJAK KEC NA IX-X

HALIMAH SARI RANI MARPAUNG PER/29/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

14 1500000000662 PUSKESMAS INDRAPURA JL. JENDRAL SUDIRMAN NO. 63 BATUBARA081376616429 PUSKESMAS INDRAPURA PER/29/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

15 1500000000663 PUSKESMAS KEDAI SIANAMJL. H.MUHAMMAD ZEIN DESA KEDAI SIANAM KEC. LIMA PULUH KAB. BATU BARA

081361449866

PUSKESMAS KEDAI SIANAM


01/01/2016 31/12/2016

16 1500000000665 PUSKESMAS LABUHAN RUKU

JL. IMAM BONJOL NO.17 KEL. LABUHAN RUKU KEC. TALAWI KAB. BATU BARA

081362061445

PUSKESMAS LABUHAN RUKU


01/01/2016 31/12/2016

17 1500000000675 PUSKESMAS LALANGJL. ACCES ROAD INALUM DESA LALANG KEC. MEDANG DERAS KAB. BATU BARA PUSKESMAS LALANG PER/29/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

18 1500000000676 PUSKESMAS LAUTADOR KEC. LAUTADOR KAB. BATU BARA PUSKESMAS LAUTADOR PER/29/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

19 1500000000666 PUSKESMAS LIMA PULUHJL. PERINTIS KEMERDEKAAN NO.73 KEL. LIMA PULUH KEC. LIMA PULUH KAB. BATU BARA

PUSKESMAS LIMA PULUH


01/01/2016 31/12/2016

20 1500000000667 PUSKESMAS PAGURAWAN JL. SUDIRMAN NO.149 KEL.P.DODEK KEC. MEDANG DERAS KAB. BATU BARA

PUSKESMAS PAGURAWAN


01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


20 / 15116-05-201607:59:01



IKS


21 1500000000668 PUSKESMAS PEMATANG PANJANG

JL. MEDAN-KISARAN NO.110 DESA PEMATANG PANJANG KEC.AIR PUTIH KAB. BATU BARA

08126470444

PUSKESMAS PEMATANG PANJANG PER/29/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

22 1500000000669 PUSKESMAS PETATAL JL. LINTAS SUMATERA KM. 131 PETATAL KEC. TALAWI KAB. BATU BARA

085275999784 PUSKESMAS PETATAL PER/29/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

23 1500000000670 PUSKESMAS SEI BALAI JL.PERINTIS KEMERDEKAAN DESA SEI BALAI KEC.SEI BALAI KAB. BATU BARA

082360571537

PUSKESMAS SEI BALAI PER/29/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

24 1500000000671 PUSKESMAS SEI SUKA JL.LINTAS SUMATERA DESA SEI SUKA DERAS KEC.SEI SUKA KAB. BATU BARA

PUSKESMAS SEI SUKA PER/29/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

25 1500000000672 PUSKESMAS SIMPANG DOLOK

DUSUN I DESA SIMPANG DOLOK KAB. BATU BARA

081361063456

PUSKESMAS SIMPANG DOLOK PER/29/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

26 1500000000673PUSKESMAS TANJUNG TIRAM

JL. RAHMADSYAH DESA.SUKA MAJU KEC. TANJUNG TIRAM KAB. BATU BARA

081264222800

PUSKESMAS TANJUNG TIRAM PER/29/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

27 1500000000674 PUSKESMAS UJUNG KUBU JL. BESAR UJUNG KUBU DUSUN IV KAB. BATU BARA

081361006865

PUSKESMAS UJUNG KUBU


01/01/2016 31/12/2016

28 1400000000294 RS SETIO HUSODOJL. SISINGAMANGARAJA NO. 67 KEL. KISARAN TIMUR KEC. KOTA KISARAN TIMUR

44999 MARDI PER/30/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

29 1500000001895 RSU AVICENNAJL. LINTAS SUMATERA SIMPANG SIRANGGONG DAMULI PEKAN KABUPATENLABUHANBATU UTARA

7672018 TOSIP TANJUNG PER/29/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

30 1500000001235 RSU TIGA BERSAUDARAJL. SIMONIS DUSUN I A DESA KAMPUNG PAJAK KECAMATAN NA IX-X

081360103239

DR M LATIF SITUMORANG PER/30/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

31 1400000000468 RSU WIRA HUSADAJL. KARTINI NO. 209 KEL. SENDANG SARI KEC. KOTA KISARAN BARAT

42532 DR. DIAH JULIANA NST PER/30/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

32 1500000000541 RSUD KABUPATEN BATU BARA

JL. DATUK KWALA GUNUNG KECAMATAN LIMA PULUH KABUPATEN BATU BARA

RSUD KABUPATEN BATUBARA


01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


21 / 15116-05-201607:59:01


KANTOR CABANG : B03- KANTOR CABANG PADANG SIDEMPUAN


IKS


1 06041 DR YUDIKA KRISTIANA JL. YOS SUDARSO NO. 160 081376630933

DR YUDIKA KRISTIANA ZENDRATO


05/04/2016 31/12/2016

2 1500000000185 KLINIK DAFFA JL SUDIRMAN LINGKUNGAN I PASAR SIBUHUAN

DR ELNI RUBIANTI DAULAY PER/16/032016 RS.TRAUMA

CENTRE 24/03/2016 31/12/2016

3 1400000000584 KLINIK HARAPAN BUNDA JL ELANG NO 35 KELURAHAN AEK MANIS 361450301 HJ NURSYAM PER/11/022016 RS.TRAUMA CENTRE 24/03/2016 31/12/2016

4 1400000000585 KLINIK MEDICA JL MANGARAJA BATANG PANE NO 56 GUNUNG TUA 396746406 DR.HJ.ZUNAIDAH

HASANAH M.KES PER/17/032016 RS.TRAUMA CENTRE 24/03/2016 31/12/2016

5 1500000000316 PRAKTEK DOKTER DIAN ASPASIA LIMBONG

JL NUSA INDAH NO 21 PADANG SIDIMPUAN 63595343 DR DIAN ASPASIA LIMBONG


03/03/2016 31/12/2016

6 1400000000583 PRAKTEK DOKTER RIKKY N HARAHAP JL R SUPRAPTO NO 70 SIBOLGA 62646523 DR RIKKY N HARAHAP PER/10/022016 RS.TRAUMA

CENTRE 24/03/2016 31/12/2016

7 1400000000580PRAKTEK DOKTER SRI PRIHATIN K N HARAHAP

JL LINTAS GUNUNGTUA-LANGGA PAYUNG DESA SIHOPUK BARU

DR SRI PRIHATIN K N HARAHAP PER/08/022016

RS.TRAUMA CENTRE 26/02/2016 31/12/2016

8 1400000000578PRAKTEK DOKTER SRI WAHYUNI

JL SULTAN HASANUDDIN NO 30 PADANG SIDIMPUAN

6455987 DR SRI WAHYUNI PER/09/022016RS.TRAUMA CENTRE

03/03/2016 31/12/2016

9 1500000000689 PRAKTEK DOKTER YUDIKA KRISTIANA

JL YOSSUDARSO NO 160 GUNUNGSITOLI DR YUDIKA KRISTIANA PER/29/042016 RS.TRAUMA CENTRE

12/04/2016 31/12/2016

10 1500000000178 PRAKTEK DR ASRIAL JL SM RAJA NO 200 PADANGSIDIMPUAN DR ASRIAL PER/14/022016 RS.TRAUMA CENTRE

03/03/2016 31/12/2016

11 1400000000186 RS METTA MEDIKA JL SUTOYO SISWOMIHARJO NO 34 SIBOLGA 25007 PT METTA MEDIKA PER/15/032016RS.TRAUMA CENTRE 10/03/2016 31/12/2016

12 1500000000477RSU PERMATA MADINA PANYABUNGAN

JL MERDEKA NO 155 PANYABUNGAN KAB MANDAILING NATAL 20279

DR H SAFII SIREGAR,SPOG PER/22/032016

RS.TRAUMA CENTRE 25/04/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


22 / 15116-05-201607:59:01



IKS


13 1500000000690 RSU PERMATA MADINA SIBUHUAN JL KIHAJAR DEWANTARA 421060 DR.MUSBAR PER/19/032016 RS.TRAUMA

CENTRE 24/03/2016 31/12/2016

14 7-2830687153 RSUD PADANGSIDIMPUAN JL F L TOBING NO 10 22711 PEMERINTAH KOTA PADANGSIDIMPUAN PER/25/032016 RS.TRAUMA

CENTRE 07/04/2016 31/12/2016

15 1400000000683 RSUD PANDAN DR FERDINAND LUMBAN TOBING NO 5 PER/26/032016 RS.TRAUMA CENTRE

24/03/2016 31/12/2016

16 1400000000344 RSUD SIBUHUAN JL KI HAJAR DEWANTARA SIBUHUAN 421678 PEMDA PER/18/032016 RS.TRAUMA CENTRE

24/03/2016 31/12/2016

17 1500000000260 RUMAH SAKIT TK IV 01.07.03 JL JEND SUDIRMAN NO 1 KAB TAPANULI SELATAN BAGINDA HARAHAP PER/20/032016 RS.TRAUMA

CENTRE 24/03/2016 31/12/2016

KANTOR CABANG : B04- KANTOR CABANG TANJUNG MORAWA


IKS


1 1500000001892BALAI PENGOBATAN HOMBING

JL. SUDIRMAN NO. 148 NO. 148 DOLOK MASIHUL

085260446061

DR. JANNES E. SIHOMBING PER/26/012016

RS.TRAUMA CENTRE 07/01/2016 31/12/2016

2 1400000000619 BPS KULON PROGOJL. BATANG KUIS GG. KANDAR NO. 8 DS TELAGA SARI TANJUNG MORAWA 7942321 DR. ARSYAD PER/20/012016

RS.TRAUMA CENTRE 07/01/2016 31/12/2016

3 1400000000033 BPS KURNIA SEHATJL. JEND SUDIRMAN LK.02 (DEPAN RS SRI PAMELA)

TAN ERFI PER/14/012016RS.TRAUMA CENTRE

07/01/2016 31/12/2016

4 1400000000031 BPS MORAWA JL. MEDAN-LUBUK PAKAM KM. 17 7942361 TAN ERFI PER/16/012016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


23 / 15116-05-201607:59:01



IKS


5 1400000000412 KLINIK 24 JAM DR. IRVAN DALIMUNTHE

JL. SOEKARNO-HATTA NO. 6 LINGKUNGAN IV PERUMAHAN TAMBANG PERMAI INDAH 23443444 DR. IRVAN DALIMUNTHE PER/18/012016 RS.TRAUMA

CENTRE 07/01/2016 31/12/2016

6 7-1240382124 KLINIK ABIZA DSN II DESAS SILAU RAKYAT KEC. SEI RAMPAH 20995 085359461

777 SAMSINAR PER/29/012016 RS.TRAUMA CENTRE 08/01/2016 31/12/2016

7 1400000000405 KLINIK ARDIFARMA JAYA JL. STASIUN DSN II KP. KELING KEC. SEI RAMPAH

441543 DR. DINI ZURIANA PER/17/012016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016

8 1400000000037 KLINIK HAMIDAH JL.MEDAN-TJ.MORAWA KM 18,5 GG. PRIBADI

7945983 DIAN SARI PER/13/012016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016

9 1400000000404 KLINIK PRATAMA AFIYAH AMPLAS

JL. PANGLIMA DENAI KOMPLEKS RUKO AMPLAS BLOK A NO. 5 80019975 DRS. H. ARENA TRI JAYA

GINTING, MM PER/19/012016 RS.TRAUMA CENTRE 07/01/2016 31/12/2016

10 1500000001880 KLINIK PRATAMA ESSIVAJL. PASAR VII NO. 16 DESA TEMBUNG KEC. PERCUT SEI TUAN 20351 7380666 DR. JHONES R. SIPAYUNG PER/24/012016

RS.TRAUMA CENTRE 07/01/2016 31/12/2016

11 1500000000070 KLINIK PRATAMA KULON PROGO BANGUN SARI

JL. MEDAN-TJ.MORAWA DESA BANGUN SARI

085275246273

DR. MUHAMMAD ARSHAD


07/01/2016 31/12/2016

12 1400000000590 KLINIK PRATAMA MANNA JL. PERTAHANAN NO. 98 PATUMBAK DR. JHONI SINAGA PER/21/012016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016

13 1500000001879 KLINIK PRATAMA MARSJALAN GALANG DUSUN IA NO. 121 DESA PURWODADI KEC. PAGAR MERBAU 20351 7952511 MARHEN, AMK PER/25/012016

RS.TRAUMA CENTRE 07/01/2016 31/12/2016

14 1500000000069 KLINIK PRATAMA PAKAM JL. MEDAN NO. 38 A LUBUK PAKAM08126523815

DR. MUSA TOGI MARPAUNG PER/22/012016

RS.TRAUMA CENTRE 07/01/2016 31/12/2016

15 7-1242107043 KLINIK PUJAJL. BESAR PETUMBUKAN NO. 12 DS PETUMBUKAN KEC. GALANG

20585 DR. BALBIR SINGH, MD PER/30/012016RS.TRAUMA CENTRE

08/01/2016 31/12/2016

16 7-1239985383 KLINIK RAIHAN MENTENG INDAH BLOK B1 NO. 29 MEDAN 20228 081265410449

DR.DRG SUCI ERAWATI M.KES


08/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


24 / 15116-05-201607:59:01



IKS


17 1400000000032 KLINIK TUTUN SEHATI JL. PASAR BARU KM 17 TJ.MORAWA A NO.2 7945676 SALMIAH ZAKARIA PER/15/012016 RS.TRAUMA CENTRE 07/01/2016 31/12/2016

18 1400000000706 PUSKESMAS ARAS KABU DESA ARAS KABU KEC. BERINGIN 082167926514 PER/27/012016 RS.TRAUMA

CENTRE 07/01/2016 31/12/2016

19 1400000000719 PUSKESMAS BANDAR BARU DESA BANDAR BARU KEC. BANDAR BARU 081397941999

PER/27/01/2016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016

20 1400000000721 PUSKESMAS BANDAR DOLOK

DESA BANDAR DOLOK KEC. BANDAR DOLOK

081376670815


07/01/2016 31/12/2016

21 1400000000709 PUSKESMAS BANDAR KHALIPAH

DESA BANDAR KHALIPAH KEC. PERCUT SEITUAN

081362408181 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

22 1400000000682PUSKESMAS BANGUN PURBA

DESA BANGUN PURBA KEC. BANGUN PURBA

085262706056 PER/27/012016

RS.TRAUMA CENTRE 08/01/2016 31/12/2016

23 1400000000707 PUSKESMAS BATANG KUIS BATANG KUIS KEC. BATANG KUIS 08126540600


08/01/2016 31/12/2016

24 1400000000681 PUSKESMAS BIRU-BIRU DESA BIRU-BIRU KEC. BIRU-BIRU 081262175005


08/01/2016 31/12/2016

25 1400000000693 PUSKESMAS DALU SEPULUH DESA DALU X KEC. BERINGIN081376077435 PER/27/012016

RS.TRAUMA CENTRE 08/01/2016 31/12/2016

26 1400000000698 PUSKESMAS DELI TUA DESA DELI TUA KEC. PATUMBAK08126432015 PER/27/012016

RS.TRAUMA CENTRE 08/01/2016 31/12/2016

27 1400000000684 PUSKESMAS GALANGJL. BUKIT BARISAN GALANG KOTA KEC. GALANG

08126587680

PER/27/01/2016RS.TRAUMA CENTRE

08/01/2016 31/12/2016

28 1400000000703 PUSKESMAS GUNUNG MERIAH

DESA GUNUNG MERIAH KEC. GUNUNG MERIAH

081397999343


08/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


25 / 15116-05-201607:59:01



IKS


29 1400000000711 PUSKESMAS HAMPARAN PERAK

DESA HAMPARAN PERAK KEC. HAMPARANPERAK

082160351011 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

30 1400000000722 PUSKESMAS KARANG ANYER

DESA KARANG ANYER KEC. KARANG ANYER

081272118888 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

31 1400000000720 PUSKESMAS KENANGAN DESA KENANGAN KEC. PERCUT SEI TUAN 085358348281


08/01/2016 31/12/2016

32 1400000000723 PUSKESMAS KOTA DATAR DESA KOTA DATAR KEC. KOTA DATAR 082164747266


08/01/2016 31/12/2016

33 1400000000726 PUSKESMAS KUTALIMBARU DESA KUTALIMBARU KEC. KUTALIMBARU 081361326400 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

34 1400000000710 PUSKESMAS LABUHAN DELI DESA LABUHAN DELI KEC. LABUHAN DELI081269230222 PER/27/012016

RS.TRAUMA CENTRE 08/01/2016 31/12/2016

35 1400000000705 PUSKESMAS LUBUK PAKAM JL. DIPONEGORO GG. WAKAF KEC. LUBUK PAKAM

085276730440


08/01/2016 31/12/2016

36 1400000000697 PUSKESMAS MULIOREJO DESA MULIOREJO KEC. SUNGGAL 081375333643


08/01/2016 31/12/2016

37 1400000000699 PUSKESMAS NAMORAMBE DESA NAMORAMBE KEC. NAMORAMBE081264262444 PER/27/012016

RS.TRAUMA CENTRE 08/01/2016 31/12/2016

38 1400000000704 PUSKESMAS PAGAR JATI DESA PAGAR JATI KEC. LUBUK PAKAM08126588410 PER/27/012016

RS.TRAUMA CENTRE 08/01/2016 31/12/2016

39 1500000000029 PUSKESMAS PANCUR BATU DESA PANCUR BATU KEC. PANCUR BATU082168463332


08/01/2016 31/12/2016

40 1400000000700 PUSKESMAS PANTAI LABU DESA PANTAI LABU KEC. PANTAI LABU 081263587546


08/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


26 / 15116-05-201607:59:01



IKS


41 1400000000694 PUSKESMAS PATUMBAK DESA PATUMBAK KEC. PATUMBAK 085275960879 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

42 1500000000030 PUSKESMAS PEMATANG JOHAR

DESA PEMATANG JOHAR KEC.PEMATANG JOHAR

082160580199 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

43 1500000000031 PUSKESMAS PETUMBUKAN DESA PETUMBUKAN KEC. PETUMBUKAN 08126415151


08/01/2016 31/12/2016

44 1400000000724 PUSKESMAS SEI MENCIRIM DESA SEI MENCIRIM KEC. SUNGGAL 081370221459


08/01/2016 31/12/2016

45 1400000000702 PUSKESMAS SEI SEMAYANG JL. SEI MENCIRIM GG. PUSKESMAS KEC. SUNGGAL

08116075420 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

46 1400000000680 PUSKESMAS SIBOLANGIT DESA SIBOLANGIT KEC. SIBOLANGIT08126420297 PER/27/01/2016

RS.TRAUMA CENTRE 08/01/2016 31/12/2016

47 1400000000725 PUSKESMAS SUKARAYA DESA SUKARAYA KEC. SUKARAYA 08126501329


08/01/2016 31/12/2016

48 1400000000701 PUSKESMAS TALUN KENAS DESA TALUN KENAS KEC. TALUN KENAS 081375190502


08/01/2016 31/12/2016

49 1400000000685PUSKESMAS TANJUNG MORAWA

KEL. TANJUNG MORAWA PEKAN KEC. TANJUNG MORAWA

081375253099 PER/27/012016

RS.TRAUMA CENTRE 08/01/2016 31/12/2016

50 1400000000708 PUSKESMAS TANJUNG REJODESA TANJUNG REJO KEC. PERCUT SEI TUAN

081264209777 PER/27/012016

RS.TRAUMA CENTRE 08/01/2016 31/12/2016

51 1400000000678 PUSKESMAS TIGA JUHAR DESA TIGA JUHAR KEC. STM HULU081265818732


08/01/2016 31/12/2016

52 1400000000030 RS GRAND MEDISTRA JL. MEDAN-LUBUK PAKAM KM.25 NO. 66 7955114 DRS. JOHANNES S PER/03/012016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


27 / 15116-05-201607:59:01



IKS


53 1500000001957 RS MORAWA UTAMA JL. MEDAN - TJ.MORAWA KM. 18,5 20351 7945058 PT. MORAWA UTAMA PER/12/012016 RS.TRAUMA CENTRE 07/01/2016 31/12/2016

54 1400000000589 RS PATAR ASIH JL. BAKARAN BATU DSN MANGGIS NO. 45 DESA TUMPATAN BERINGIN 7950449 NATANIEL P.

NAINGGOLAN, SH PER/06/012016 RS.TRAUMA CENTRE 08/01/2016 31/12/2016

55 1500000001981 RS SRI PAMELA JL. JEND. SUDIRMAN NO. 299 24748 PT. SRI PAMELA MEDIKA NUSANTARA


07/01/2016 31/12/2016

56 1400000000038 RSU DR.GL TOBING PTPN II JL.RAYA MEDAN-TJ.MORAWA KM 16,5 20362 7944796 PTPN II (PERSERO) PER/01/012016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016

57 1400000000035 RSU HERNA JL. BALAI KOTA NO. 2 21476 DR. DJOHAN ZEIN PER/02/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

58 1400000000622 RSU MELATI PERBAUNGAN JL. DELI NO. 105-115 PERBAUNGAN 7990056 DR. TONDY PER/07/012016RS.TRAUMA CENTRE 08/01/2016 31/12/2016

59 1400000000587 RSU MITRA SEHAT JL. SEI MERAH NO. 300 DESA DAGANG KERAWANG

77607489 DR. SUSI, MKT PER/05/012016 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

60 1400000000620 RSU SARI MUTIARA LUBUK PAKAM

JL. MEDAN NO. 17 LUBUK PAKAM 7951339 DRS. WASHINGTON PURBA


08/01/2016 31/12/2016

61 1500000000099 RSU SEMBIRING DELI TUA JL. BESAR NO. 77 DELI TUA 7030802 DRS. JOHANNES S PER/08/012016RS.TRAUMA CENTRE 07/01/2016 31/12/2016

62 1500000000248 RSUD DELI SERDANG JL. THAMRIN LUBUK PAKAM 7952068 PEMKAB DELI SERDANG PER/09/012016RS.TRAUMA CENTRE 08/01/2016 31/12/2016

63 1500000000204 RSUD SULTAN SULAIMAN JL. NEGARA KM 58 NO. 315 SEI RAMPAHPEMKAB SERDANG BEDAGAI


08/01/2016 31/12/2016

KANTOR CABANG : B05- KANTOR CABANG MEDAN BELAWAN


Periode : 01/01/2016 s/d 31/12/2016


28 / 15116-05-201607:59:01



IKS


1 1500000000054 BALAI PENGOBATAN DELIMA JL.MEDAN BELAWAN KM 21.5 MEDAN NURDELIMA SIHOMBING PER/08/2015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

2 1500000000053 KLINIK AZIZI JL.TEMPULING NO.111 A MEDAN DR.ANITAWATI PER/05/2015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

3 1500000001219 KLINIK BINA SEJAHTERA JL.K.L YOS SUDARSO NO.68 DISIPLIN ROSALINA G PER/09/2015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

4 1400000000331 KLINIK CITRA MEDIKA JL.PLATINA RAYA NO.58 MEDAN DR.YUDA PRAYOGI PER/04/2015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

5 1500000000231 KLINIK DANDY JALAN RUMAH POTONG HEWAN NO.15 A 20241 66516974 SITI HAWA MANAO PER/01/2015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

6 1500000000250 KLINIK HAJI KRAKATAU JALAN KRAKATAU NO.48 A/110 MEDAN TAKBIR SIREGAR PER/11/2015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

7 7-1135974186 KLINIK HAJI MEDAN KRAKATAU

JL KRAKATAU NO 48 A / 110 MEDAN 20241 TAKBIR SIREGAR PER/11/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

8 1500000000251 KLINIK HAJI MEDAN PANCING

JALAN WILLIEM ISKANDAR /PANCING NO.100 C

TAKBIR SIREGAR PER/10/2015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

9 1500000000052 KLINIK HELVETIA III JL.KL YOS SUDARSO SP.KANTOR TEGUH SUHARTO PER/06/2015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

10 1500000000051 KLINIK HELVETIA VIII JL.KL YOS SUDARSO KM 20,5 MEDAN TEGUH SUHARTO,SE PER/07/2015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

11 1500000000459KLINIK MUTIARA KOTA BANGUN

JL KL YOS SUDARSO KM 10.5 20241 96333303 NURHAYATI PURBA PER/02/2015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

12 7-1919381394 KLINIK PRATAMA HARAPANSEHAT SEJAHTERA

JL MARELAN RAYA BESI PUTIH MEDAN KEL TANAH ENAM RATUS

20245 WENDY PER/02/022016 RS.TRAUMA CENTRE

04/02/2016 31/01/2017


Periode : 01/01/2016 s/d 31/12/2016


29 / 15116-05-201607:59:01



IKS


13 7-1919381394 KLINIK PRATAMA HARAPANSEHAT SEJAHTERA

JL MARELAN RAYA BESI PUTIH MEDAN KEL TANAH ENAM RATUS 20245 WENDY PER/02/022016 RS.TRAUMA

CENTRE 05/02/2016 31/12/2016

14 7-1918653373 KLINIK PRATAMA MEDAN DELI INDONESIA

JL KL YOS SUDARSO NO 109 A KEL TANJUNG MULIA KEC MEDAN DELI 20241 DR JOHNY HENDRIK PER/01/022016 RS.TRAUMA

CENTRE 04/02/2016 31/01/2017

15 7-1918653373 KLINIK PRATAMA MEDAN DELI INDONESIA

JL KL YOS SUDARSO NO 109 A KEL TANJUNG MULIA KEC MEDAN DELI

20241 DR JOHNY HENDRIK PER/01/022016 RS.TRAUMA CENTRE

05/02/2016 31/12/2016

16 7-3300073231 KLINIK QYTA MEDIKA JL KAPTEN RAHMAD BUDIN LINGKUNGAN 13 KELURAHAN TERJUN

20111 CHELLIA PER/03/052016 RS.TRAUMA CENTRE

12/05/2016 31/12/2016

17 1400000000332 KLINIK TIMUR JAYA JL.KL.YOS SUDARSO KM 10,6 MEDAN DR.KURNIAWAN PER/03/2015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

18 1400000000336 RS MARTHA FRISKA JALAN KL YOS SUDARSO NO.91 MEDAN RASIN BBA,MHA PER/14/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

19 1400000000455 RSU MITRA MEDIKA JL KL YOS SUDARSO KM 7.5 TJ MULIA DR. HANIFAH, M. KES PER/15/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

20 1400000000335 RUMAH SAKIT IMELDA JALAN BILAL NO.24 P.BRAYAN DR.IMELDA LIANA RITONGA


01/01/2016 31/12/2016

21 7-3299717470RUMAH SAKIT METHODIST MEDAN JALAN M H THAMRIN NO 105 20115

0617369000

DR HENDRA W DJUANG MARS PER/04/052016

RS.TRAUMA CENTRE 12/05/2016 31/12/2016

22 1400000000334RUMAH SAKIT PELABUHAN BELAWAN JL.STASIUN NO.92 BELAWAN 6941927

PT.PELABUHAN INDONESIA PER/12/2015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

KANTOR CABANG : B06- KANTOR CABANG BINJAI


Periode : 01/01/2016 s/d 31/12/2016


30 / 15116-05-201607:59:01



IKS


1 1500000000067 BPS SARANA JL BINJAI KM 11.7 NO 57 DESA PUJIMULYO SUNGGAL PER/01/012016 RS.TRAUMA

CENTRE 27/01/2016 31/12/2016

2 1500000001924 KLINIK PRATAMA SEHAT SEHATI JL RAYA BINJAI KM 14.6 DISKII 20351 370139966 DR ELVII SUSANTI

SITEPU PER/23/042016 RS.TRAUMA CENTRE 10/05/2016 31/12/2016

3 7-1958871584 KLINIK PRATAMA DOA IBU JL SUDIRMAN LINGK II SETIA NO 53 PERDAMAIAN

20811 H BUDIANTO WAHYU WARDOYO


10/02/2016 31/12/2016

4 7-3004856563 KLINIK PRATAMA DORARA JL SETIA AGUNG GG MAWAR I 20351 SUHAINI PER/19/042016 RS.TRAUMA CENTRE

25/04/2016 31/12/2016

5 1500000000430 KLINIK PRATAMA SARI MUTIARA TANDEM

JL TANJUNG PURA NO 98 DESA TANDEM HILIR HAMPARAN PERAK 396880292 DR TUAHMAN PER/12/022016 RS.TRAUMA

CENTRE 29/04/2016 31/12/2016

6 7-2570400503KLINIK PRATAMA SEMPURNA JL GATOT SUBROTO NO 335 20719 ESRA SEMBIRING PER/06/022016

RS.TRAUMA CENTRE 24/03/2016 31/12/2016

7 1500000000068 KLINIK PRIMA MEDIKA JL KH ZAINUL ARIFIN NO 1 A KEC STABAT MANGIHUT MARATUA PER/17/032016 RS.TRAUMA CENTRE

04/06/2016 31/12/2016

8 7-1958581253 KLINIK UTAMA MENTARI JL T AMIR HAMZAH KEL KWALA LANGKAT 20761 EMA PURNAMA PER/02/022016 RS.TRAUMA CENTRE

10/02/2016 31/12/2016

9 7-3113228247 RS AL-FUADI JL AHMAD YANI BINJAI 20711 DR H T MURAD ALFUAD PER/22/0416RS.TRAUMA CENTRE 28/04/2016 31/12/2016

10 1500000000213 RS BANGKATAN PTPN II JL SULTAN HASANUDDIN NO 40 BINJAI 75080063 PTPN II PER/09/022016RS.TRAUMA CENTRE 17/02/2016 31/12/2016

11 7-2048054644 RSU ARTHA MEDICA BINJAI JL SAMANHUDI NO 22 BINJAI 20711 ARUSTA TARIGAN PER/08/022016RS.TRAUMA CENTRE

17/02/2016 31/12/2016

12 7-2030604103 RSU BIDADARI JL. PERINTIS KEMERDEKAAN NO 147 BINJAI 20744 FIRMANSYAH SE MARS PER05/022016 RS.TRAUMA CENTRE

16/02/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


31 / 15116-05-201607:59:01



IKS


13 7-2030604103 RSU BIDADARI JL. PERINTIS KEMERDEKAAN NO 147 BINJAI 20744 FIRMANSYAH SE MARS PER/05/022016 RS.TRAUMA CENTRE 16/02/2016 31/07/2017

14 7-2502663572 RSU DELIA JL KH DEWANTARA DUSUN I SEI LIMBAT 20762 NGOGESA SITPU PER/16/032016 RS.TRAUMA CENTRE 15/03/2016 31/12/2016

15 1500000000429 RSU KELIAT JL SULTAN ARAB NO 111 DESA KLUMPANG KAMPUNG HAMPARAN PERAK

PRATEN NATALIA BR KELIAT


04/05/2016 31/12/2016

16 1500000000429 RSU KELIAT JL SULTAN ARAB NO 111 DESA KLUMPANG KAMPUNG HAMPARAN PERAK

PRATEN NATALIA BR KELIAT


29/04/2016 31/01/2017

17 7-2047722993 RSU LATERSIA JL SOEKARNO HATTA NO 451 20731 ROBINSON SEMBIRING PER/07/022016 RS.TRAUMA CENTRE 17/02/2016 31/12/2016

18 7-3113910618 RSU RATU MAS JL T AMIR HAMZAH NO 281 A 20744PT ROYA L MEDIKA RAYA PER/20/0416

RS.TRAUMA CENTRE 28/04/2016 31/12/2016

19 7-2446378422 RSUD TANJUNG PURA JL KHAIRIL ANWAR TANJUNG PURA 20853 PEMERINTAH PER/15/032016 RS.TRAUMA CENTRE

10/03/2016 31/12/2016

KANTOR CABANG : B23- KABUPATEN NIAS


IKS


1 7-3063241293 KLINIK PRATAMA SEHAT JL LAGUNDRI NO 57 GUNUNGSITOLI 22811 MANY PER/28/042016RS.TRAUMA CENTRE

25/04/2016 31/12/2016

KANTOR CABANG : C00- KANTOR CABANG PADANG


Periode : 01/01/2016 s/d 31/12/2016


32 / 15116-05-201607:59:01



IKS


1 1400000000040 KLINIK ARUM SARI JL SUTAN SYAHRIL NO.332 081363474133 DR FERI MULYANI PER/44/122015 RS.TRAUMA

CENTRE 01/02/2016 31/12/2016

2 1500000000954 KLINIK INTRO MEDIKA JL H AGUS SALIM NO 19 811150 NURMIDALMI, SE PER/20/042016 RS.TRAUMA CENTRE 04/05/2016 31/12/2017

3 7-3171683333 KLINIK PT. KSI JORONG SUNGAI TANGAH KENAGARIAN SUNGAI KUNYIT

27777 PT. KSI PER/23/052016 RS.TRAUMA CENTRE

04/05/2016 31/12/2017

4 1500000000813 KLINIK SAMUDRA MEDIKA JL PALEMBANG NO 20 GAUNG ANI GUSMELA DEWISKA S, SIT


04/05/2016 31/12/2016

5 7-2810976383 KLINIK TIN ISKANDAR MEDIKAL JL M YAMIN SH NO 21 KAMPUNG BARU 25511 67191675 H ISKANDAR AS PER/14/032016 RS.TRAUMA

CENTRE 05/04/2016 31/12/2016

6 1500000000635RS BHAYANGKARA PADANG JL JATI NO 1 PADANG POLDA SUMBAR PER/05/022016

RS.TRAUMA CENTRE 01/04/2016 31/12/2016

7 1500000000767 RS KHUSUS BEDAH KARTIKA DOCTA

JL. GAJAH MADA NO. 14 GUNUNG PANGILUN

4481278 H. MUSTAFA KAMAL PER/06/022015 RS.TRAUMA CENTRE

01/04/2016 31/12/2016

8 1500000001054 RS SELAGURI JL JEND A. YANI NO 26 DR HJ HAFLEZIANI M.KES


01/05/2016 31/12/2017

9 1400000000039RS TENTARA REKSODIWIRYO JL DR WAHIDIN NO.1 PADANG 31003

DATASEMEN KESEHATAN PER/45/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

10 7-2995836423RSJ PROF HB SAANIN PADANG

JL. RAYA ULU GADUT KEL LIMAU MANIS SELATAN 25161 PEMPROV SUMBAR PER/19/042016

RS.TRAUMA CENTRE 21/04/2016 31/12/2016

11 1500000000955 RSUD DR M ZEIN PAINAN JL DR A RIVAI KOTA PAINAN2142821518

PEMDA PESISIR SELATAN


04/05/2016 31/12/2017

12 7-2895404723 RSUD MENTAWAI JL. RAYA TUAPEJAT KM 9 KEC SIPORA UTARA

25392 PEMDA KAB KEP MENTAWAI


18/04/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


33 / 15116-05-201607:59:01



IKS


13 1500000000914 RSUD PARIAMAN JL PROF M YAMIN SH NO 5 91118-91428 PEMPROV SUMBAR PER/18/042016 RS.TRAUMA

CENTRE 01/05/2016 31/12/2016

14 1500000000507 RUMAH SAKIT KHUSUS BEDAH ROPANASURI JL. AUR NO. 8 PADANG 31938 DR. QUINTA SARI, SP. KK PER/03/022016 RS.TRAUMA

CENTRE 01/04/2016 31/12/2016

15 1500000000507 RUMAH SAKIT KHUSUS BEDAH ROPANASURI

JL. AUR NO. 8 PADANG 31938 DR. QUINTA SARI, SP. KK PER/03/012016 RS.TRAUMA CENTRE

01/04/2016 31/12/2016

16 1500000000534RUMAH SAKIT UMUM BHAKTI KESEHATAN MASYARAKAT (BKM)

JLN JENDRAL SUDIRMAN SAGO KENAGARIAN SAGO-SALIDO KEC IV JURAI

63385109 MAWARDI PER/04/022016 RS.TRAUMA CENTRE

01/04/2016 31/12/2016

KANTOR CABANG : C01- KANTOR CABANG BUKIT TINGGI


IKS


1 1400000000280 PRAKTEK DR SYAHRIL SJORONG SUDIRMAN, NAGARI MUARO KIAWAI, KEC. GUNUNG TULEH, PASAMAN BARAT

DR SYAHRIL S PER/015/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

2 1400000000223RSI IBNU SINA PAYAKUMBUH JL PEMUDA NO 14 PAYAKUMBUH 92222

YARSI SUMATERA BARAT PER/013/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

3 1400000000239RSI IBNU SINA SIMPANG AMPEK

JL M. NATSIR PASAMAN BARU SIMPANG EMPAT PASAMAN BARAT 7464015

YAYASAN RUMAH SAKITISLAM SUMATERA BARAT

PER/014/072014RS.TRAUMA CENTRE 01/01/2016 31/12/2016

4 1400000000239RSI IBNU SINA SIMPANG AMPEK

JL M. NATSIR PASAMAN BARU SIMPANG EMPAT PASAMAN BARAT

7464015YAYASAN RUMAH SAKITISLAM SUMATERA BARAT


01/01/2016 31/12/2016

5 1400000000063 RSUD DR ACHMAD MOCHTAR BUKITTINGGI

JL. DR . A. RIVAI BUKITTINGGI 21720 PEMERINTAH PROVINSI SUMATERA BARAT


01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


34 / 15116-05-201607:59:01


KANTOR CABANG : C02- KANTOR CABANG SOLOK


IKS


1 1500000000548 BALAI LATIHAN KERJA KABUPATEN SOLOK

JL RAYA LUBUK SELASIH KM 01 KAYU ARO ZULFAKHRI,S.SOS PER/18/122015 RS.TRAUMA CENTRE

05/01/2016 31/12/2016

2 1400000000099 BLUD-RSUD SAWAHLUNTO JL KARTINI NO 18 74066837 PER/07/122015 RS.TRAUMA CENTRE 21/01/2016 31/12/2016

3 1500000000749 KLINIK ALTHAF JL M YAMIN NO 83 DR.DINI ASTA DIANI PER/14/122015 RS.TRAUMA CENTRE 21/01/2016 31/12/2016

4 1500000000722 KLINIK ARBA NAGARI SUNGAI RUMBAI TIMUR KEC SUNGAI RUMBAI YUSNIMAR SST PER/12/122015 RS.TRAUMA

CENTRE 05/01/2016 31/12/2016

5 1500000000761 KLINIK KURNIA JL DT PERPATIH NAN SABATANG KOTA SOLOK

EVAMAIROZA,SE,M.KES PER/15/122015 RS.TRAUMA CENTRE

21/01/2016 31/12/2016

6 1500000000948 KLINIK PRATAMA NURJINIS JL BUKIT BERBUNGA NAGARI SUNGAI RUMBAI TIMUR NURJINIS PER/13/122015 RS.TRAUMA

CENTRE 05/01/2016 31/12/2016

7 1500000000895PUSKESMAS ALAHAN PANJANG

KEC LEMBAH GUMANTI KABUPATEN SOLOK PER/16/122015

RS.TRAUMA CENTRE 05/01/2016 31/12/2016

8 1500000000547RSUD AROSUKA KABUPATEN SOLOK

JL LINTAS SUMATERA AROSUKA KABUPATEN SOLOK

DR.I.NYOMAN ARDANA PUTRA


21/01/2016 31/12/2016

9 1500000000464 RSUD SIJUNJUNG JL LINTAS SUMATRA KM 110 TANAH BADANTUANG

20056 PER/08/122015 RS.TRAUMA CENTRE

21/01/2016 31/12/2016

10 1400000000017 RSUD SOLOK SIMPANG RUMBIO KOTA SOLOK 20826 RSUD SOLOK PER/09/122015 RS.TRAUMA CENTRE

21/01/2016 31/12/2016

11 1500000000466 RSUD SUNGAI DAREHJL LINTAS SUMATERA KM 2 PULAU PUNJUNG 40347 PER/11/122015

RS.TRAUMA CENTRE 05/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


35 / 15116-05-201607:59:01


KANTOR CABANG : D00- KANTOR CABANG PEKANBARU KOTA


IKS


1 7-2918533335 AULIA HOSPITAL JL. HR SUBRANTAS NO. 63 28293 6700.000 PT. PUTERI AULIA DITA MEDICA


18/04/2016 31/12/2016

2 7-2146926741 KLINIK DR. ANDAN DEWI JL. LINTAS TIMUR KM 34 28383 DR. SITI ANDAN DEWI PER/06/022016 RS.TRAUMA CENTRE 26/02/2016 31/12/2016

3 1500000001877 KLINIK FELLITA JL. KAHARUDDIN NASUTION NO. 145-146 MAHARATU MARPOYAN DAMAI 28111 68401901 DR. YANTI FATMI, DK PER/35/072015 RS.TRAUMA

CENTRE 30/03/2016 31/12/2016

4 1500000001988 KLINIK FIDYA JL. LINTAS TIMUR - PASAR SOREK SATU 72026643 DR. IMAN RANDAL TARIGAN, SP.PD PER/41/102015 RS.TRAUMA

CENTRE 30/03/2016 31/12/2016

5 1500000001878 KLINIK PELITA HATI JALAN RAYA TALUK KUANTAN DESA LUBUK SAKAT PERHENTIAN RAJA

28411 76892989 FEBRIAN CHASRA,SE.S.FILL


30/03/2016 31/12/2016

6 1500000001770 KLINIK PRATAMA BMC PEKANBARU

JL. PAUS NO. 32 F LIMBUNGAN BARU RUMBAI PESISIR 28262 05617614 ARMAINI, SH PER/31/062015 RS.TRAUMA

CENTRE 30/03/2016 31/12/2016

7 7-492772759KLINIK PRATAMA CENDANA HUSADA JL. JATI NO. 76 SENAPELAN 28151 HJ. ELLIYANNORA PER/46/112015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

8 7-522122673KLINIK PRATAMA TIFFANY MEDIKA

JL. LINTAS TIMUR BANDAR SEI KIJANG 28383 HERMALINDA PER/48/112015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

9 1200000000002 RS AWAL BROS JL JENDRAL SUDIRMAN NO 117 47333 PT AWAL BROS PUTRA 82/IKS/0612 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

10 1500000000241 RSUD SIAK SRI INDRAPURA JL SEI KECIL KABUPATEN SIAK 20012 HJ.ULFAH HANUM PER/08/032015 RS.TRAUMA CENTRE

28/02/2016 31/12/2016

11 7-300282953RUMAH SAKIT ISLAM IBNU SINA JL. MELATI NO. 60 28122 0761 24242 PT. SYIFA UTAMA PER/45/112015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

12 1500000001341RUMAH SAKIT PEKANBARU MEDICAL CENTER

JALAN LEMBAGA PEMASYARAKATAN NO. 25 GOBAH, PEKANBARU 848100

PT. PEKANBARU MEDIKAL SENTER PER/27/062015

RS.TRAUMA CENTRE 30/03/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


36 / 15116-05-201607:59:01



IKS


13 1500000000141 RUMAH SAKIT TENTARA PEKANBARU JL KESEHATAN NO 1 PEKANBARU 22426 DR.YUDHI DORANDES PER/02/022015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

KANTOR CABANG : D01- KANTOR CABANG TANJUNG PINANG


IKS


1 1400000000014 BALAI PENGOBATAN TIARA MEDIKA JL. TELUK SASAH TANJUNG UBAN 484427 DR ERIKA M KAMIL PER/57/022016 RS.TRAUMA

CENTRE 04/03/2016 31/12/2016

2 1500000000461 KLINIK ANANDA JALAN D.I PANJAITAN KM 1008127027685 KLINIK ANANDA PER/59/122015

RS.TRAUMA CENTRE 26/03/2016 31/12/2016

3 1500000001213 KLINIK AZZAHRA JL. HANG JEBAT KIJANG KLINIK AZZAHRA PER/66/2015 RS.TRAUMA CENTRE

27/04/2016 31/12/2016

4 1500000000924 KLINIK ERNES JL.PERMAISURI NO.08 TANJUNG UBAN KEPULAUAN RIAU

085265696020

DR.ODRI ANGNES T PER/67/122015 RS.TRAUMA CENTRE

01/05/2016 31/12/2016

5 1500000001281KLINIK ERNES PT. ALAM INDAH BINTAN JL. LOT 1-2-3 LAGOI DR. ODRI ANGNES T PER/07/012016

RS.TRAUMA CENTRE 11/06/2016 31/12/2016

6 05338PPK-I RSUP KEPULAUAN RIAU - TG UBAN JL INDUN SURI , TANJUNG UBAN 482655

PEMERINTAH PROPINSI KEPRI PER/64/122015

RS.TRAUMA CENTRE 04/03/2016 31/12/2016

7 00306PRAKTEK DR. ERWIN BUNTORO

JL PERMAISURI TANJUNG UBAN081372490663

DR. ERWIN BUNTOROPER / 61 / 122015

RS.TRAUMA CENTRE

09/03/2016 31/12/2016

8 1500000000321 PUSKESMAS KAMPUNG BUGIS

JALAN ABDUL RAHIM KELURAHAN KAMPUNG BUGIS, TANJUNGPINANG

PUSKESMAS KAMPUNG BUGIS


09/03/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


37 / 15116-05-201607:59:01



IKS


9 1500000000923 PUSKESMAS MEKAR BARU JL CENDERAWASIH KM 8 TANJUNGPINANG 7003559 RIAMA SARAGI PER/68/122015 RS.TRAUMA CENTRE 01/05/2016 31/12/2016

10 1500000000638 PUSKESMAS MELAYU KOTA PIRING

JL. KIJANG LAMA BATU 7 KEL. MELAYU KOTA PIRING, KEC. TJ PINANG TIMUR

PUSKESMAS MELAYU KOTA PIRING PER/69/122015 RS.TRAUMA

CENTRE 27/04/2016 31/12/2016

11 00311 RSAL DR MIDIYANTO JL CIPTADI 1 21428 PER/14/032016 RS.TRAUMA CENTRE

04/03/2016 31/12/2016

12 1400000000093 RSUD KABUPATEN BINTAN JL. BAREK MOTOR NO 2B KIJANG RSUD KABUPATEN BINTAN


29/04/2016 31/12/2016

13 1400000000061 RSUD KERPI TANJUNG UBAN 482795 PEMERINTAH PROPINSI

KEPRI PER/64/122015 RS.TRAUMA CENTRE 04/03/2016 31/12/2016

14 1500000000462RSUD KOTA TANJUNGPINANG JL SUDIRMAN 795 313000

RSUD KOTA TANJUNGPINANG PER/18/032015

RS.TRAUMA CENTRE 30/03/2016 31/12/2016

15 1400000000013 RSUP KEPRI TANJUNGPINANG KM 8

JL. BARU SUNGAI CARANG KM.8 TANJUNGPINANG

PEMERINTAH PROVINSI KEPULAUAN RIAU


07/03/2016 31/12/2016

16 7-2375079192RUMAH SAKIT ANGKATAN LAUT DR MIDIYATO S TANJUNG PINANG

JALAN CIPTADI NO I TANJUNGPINANG 29111 DR. AHMAD SAMSULHADI


04/03/2016 31/12/2016

KANTOR CABANG : D02- KANTOR CABANG BATAM NAGOYA


IKS


1 1400000000048 BATAMINDO INDUSTRIAL PARK KLINIK

JL DADAP BLOK A TOWN CENTER UNIT1-6 BATAMINDO INDUSTRIAL PARK MUKAKUNING BATAM

29433 611907BATAMINDO INDUSTRIAL PARK KLINIK


01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


38 / 15116-05-201607:59:01



IKS


2 1400000000382 BP BATAM VIEW BEACH RESORT

KOMPLEK BATAM VIEW BEACH RESORT JL.HANG LEKIR NONGSA 29466 761740 DR MELATI PER/62/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

3 1400000000026 BP BUDI ROSARI JALAN MAHKOTA SIMPANG NO.1 BENGKONG MAHKOTA BATAM 29458 BC GULIMAN

MANURUNG PER/58/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

4 1400000000595 BP HARAPAN KITA BATU AJI RUKO CENTRAL MUKA KUNING BLOK A NO.8 BATU AJI

29438 0778361475

PT AUDY JAYA PRATAMA


04/01/2016 31/12/2015

5 1400000000025 BP HARAPAN KITA PURI LEGENDA

RUKO PURI LEGENDA BLOK D3 NO.17 BATAM

29464 8096104 YULIANA AMD.KEB SE PER/50/12015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

6 1500000000587 BP HARAPAN KITA SUKAJADI

KOMP.RUKO TAMAN NIAGA BLOK N NO.03 SUKAJADI BATAM KOTA 29464 7372056 YULIANA AMD.KEB, SE PER/51/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

7 1500000000348 KLINIK ALAM SEHAT KABILKOMP RUKO TAMAN JASINTA INDAH BLOKA NO 15-16 KEL KABIL KEC NONGSA BATAM

29467 711569EMMI KRISTIANI SIREGAR PER/64/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

8 1400000000644 KLINIK BATAMEDIKAKOMPLEK SAMPURNA CENTER BLOK F NO 07 KEL DURIANGKANG KEC SEI BEDUK TANJUNG PIAYU

29437 64212392 DR KRISMADIES M.KKK PER/48/122015 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

9 1500000000822 KLINIK HUSADATAMA JL.IMAM BONJOL KOMP.GALAXY NO.3-4 NAGOYA BATAM

29444 431457 DR.KRISMADIES, M.KKK PER/57/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

10 1400000000072 KLINIK MEDIKAJL R.E MARTADINATA, KOMP WIJAYA BLOK G NO.5 SEKUPANG. BATAM 29425

082389094888 DR KRISMADIES, M.KKK PER/53/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

11 1400000000466KLINIK NAYAKA HUSADA 03KABIL

RUSUNAWA BPJS KETENAGAKERJAAN KABIL 29467 711448

PT NAYAKA ERA HUSADA PER/64/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

12 1400000000074KLINIK NAYAKA HUSADA 04NAGOYA

JL RAJA ALI HAJI JODOH KOMP TANJUNG PANTUN BLOK U NO.6 NAGOYA BATAM

29454 457857 DODDY SUDRAJAT PER/60/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

13 1400000000071 KLINIK PANBIL MEDIKA KOMP. PERDAGANGAN PANBIL BLOK A NO.9 MUKA KUNING BATAM

29433 371338 DR KRISMADIES, M.KKK PER/52/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


39 / 15116-05-201607:59:01



IKS


14 1500000000821 KLINIK PRIMA HUSADA KOMPLEK RUKO SMK ALJABAR BLOK B NO.3 BENGKONG INDAH BATAM 29458 61433634 DR.KRISMADIES,M.KKK PER/56/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

15 1500000000819 KLINIK PURI SEHAT RUKO PURI LEGENDA BLOK D3 NO.9 BATAM CENTER 29464 38701249 DR KRISMADIES, M.KKK PER/54/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

16 1400000000297 KLINIK TAMARA JL ENGKU PUTRI RUKO TAMAN LAKOTA BLOK F NO 8-9 BATAM CENTER

29464 8097629 DR ANJARI WAHYU WARDHANI


01/01/2016 31/12/2016

17 1500000000820 KLINIK XYSTERA KOMPLEK GENTA PLAZA BLOK B NO. 5-6 MUKA KUNING BATAM

29439 7293995 DR KRISMADIES, M.KKK PER/55/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

18 0900000000028 RS AWAL BROS JL GAJAH MADA KAV I BALOI 431777 DR WIDYA PUTRI PER/01/012016 RS.TRAUMA CENTRE 11/01/2016 31/03/2016

19 0700000000015 RS CAMATHA SAHIDYA JL A YANI NO. 8 MUKA KUNING 29433 371003 PT CAMATHA SAHIDYA PER/65/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

20 1300000000017 RS HARAPAN BUNDA JL SERAYA 01. BATAM 29452 457333 YAYASAN HARAPAN BUNDA


01/01/2016 31/12/2016

KANTOR CABANG : D03- KANTOR CABANG DUMAI


IKS


1 1400000000208BALAI PENGOBATAN MUTIARA KASIH

JL RAYA LUBUK GAUNG RT 008 SEI SEMBILAN

IR BURJU SIHOMBINGPER / 21 / 062015

RS.TRAUMA CENTRE

18/04/2016 31/05/2016

2 1500000000239 BP AMANAH JL SOEKARNO HATTA KM 14 BAGAN BESAR 28882 DR. DEVY DIANNY PER/45/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


40 / 15116-05-201607:59:01



IKS


3 1400000000024 KLINIK RAWAT INAP TUNAS MUDA MEDIKA JL WAN DAHLAN IBRAHIM NO 8 DUMAI 28811 439026 DR RAHMI SALBI PER/47/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

4 1500000000623 KLINIK AL UMMI JL BELIMBING NO.123 KEL RIMBA SEKAMPUNG KEC. DUMAI KOTA 28811 34351 ANDI RONI PER/43/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

5 1500000000622 KLINIK AL UMMI SUNGAI SEMBILAN

JL. MAMPU JAYA KEL. TANJUNG PENYEMBAL KEC.SEI SEMBILAN

28813 34351 ANDI RONI PER/44/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

6 1400000000518 KLINIK ROHIL MEDIKA JL LINTAS BAGANSIAPIAPI LENGGADAI HILIR KEC RIMBA MELINTANG

28953 MUHAMMAD SYUKRI PER/48/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

7 1500000000238 KLINIK SEHATI JL. PANGERAN DIPONEGORO/SUKAJADI NOMOR 83B 28811 34584 DR. H. SUNARYO PER/46/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

8 1500000000424 PKM BUKIT KAPURJL. SOEKARNO HATTA KM 17 KEL BAGAN BESAR 78050705

DINAS KESEHATAN KOTA DUMAI PER/10/03/2016

RS.TRAUMA CENTRE 04/04/2016 31/03/2017

9 1500000000426 PKM BUKIT KAYU KAPUR JL. SOEKARNO HATTA KM 27,5 KEL BUKIT KAYU KAPUR

78799339 DINAS KESEHATAN KOTA DUMAI


04/04/2016 31/03/2017

10 1500000000432 PKM BUKIT TIMAH KOMP. BTN BUMI DUMAI BARU KEL BUKIT TIMAH



04/04/2016 31/03/2017

11 1500000000423 PKM BUMI AYU JL. BUDI UTOMO KEL BUMI AYU 18177095DINAS KESEHATAN KOTA DUMAI PER/07/032016

RS.TRAUMA CENTRE 04/04/2016 31/03/2017

12 1500000000422 PKM DUMAI BARAT JL. MH THAMRIN KEL PANGKALAN SESAI 07593322DINAS KESEHATAN KOTA DUMAI PER/05/032016

RS.TRAUMA CENTRE 04/04/2016 31/03/2017

13 1500000000419 PKM DUMAI KOTAJL. PATTIMURA KEL.DUMAI KOTA KEC. DUMAI KOTA

76879661DINAS KESEHATAN KOTA DUMAI


04/04/2016 31/03/2017

14 1500000000421 PKM JAYAMUKTI JL. KH NASUTION KEL. JAYA MUKTI 83771888 DINAS KESEHATAN KOTA DUMAI


04/04/2016 31/03/2017


Periode : 01/01/2016 s/d 31/12/2016


41 / 15116-05-201607:59:01



IKS


15 1500000000425 PKM MEDANG KAMPAI JL. RAYA DUMAI SEI PAKNING KM 11 KEL. TELUK MAKMUR 28065693 DINAS KESEHATAN

KOTA DUMAI PER/11/03/2016 RS.TRAUMA CENTRE 04/04/2016 31/03/2017

16 1500000000420 PKM PURNAMA JL. TUN SRI LANANG NO.3A KEL. PURNAMA 66780687 DINAS KESEHATAN KOTA DUMAI PER/06/032016 RS.TRAUMA

CENTRE 04/04/2016 31/03/2017

17 1500000000433 PKM SUNGAI SEMBILAN JL. RAYA DUMAI BASILAM BARU KM 14 KEL. LUBUK GAUNG



04/04/2016 31/03/2017

18 1400000000492 RS CAHAYA JL LINTAS RIAU UJUNG TANJUNG 28983 66818300 DRG CAHAYA PURNAMASARI


01/01/2016 31/12/2016

19 1300000000020 RSUD DUMAI JL TANJUNG JATI NO 4 38367 PEMKO DUMAI PER/50/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

KANTOR CABANG : D04- KANTOR CABANG RENGAT


IKS


1 7-2792259267 KLINIK PRATAMA THIP REGIONAL OFFICE PULAI 29255 PT THIP PLANTATIONS PER/01/042016RS.TRAUMA CENTRE 05/04/2016 31/03/2017

KANTOR CABANG : D05- KANTOR CABANG DURI


IKS


1 1400000000092 BALAI PENGOBATAN DIAN HUSADA

JL. GAJAH MADA NO. 31 SEBANGA DURI 92404 HARIANSYAH PER/06/042015 RS.TRAUMA CENTRE

01/04/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


42 / 15116-05-201607:59:01



IKS


2 1400000000086 BALAI PENGOBATAN DURI MEDIKA

JL. JEND SUDIRMAN RT/RW 02/05 KEL. BALAI MAKAM DURI 594469 NENNI TRIANA PER/07/042015 RS.TRAUMA

CENTRE 01/04/2016 31/12/2016

3 1500000000412 KLINIK NAYAKA HUSADA DURI

JL DEWI SARTIKA KELURAHAN BALIK ALAM KECAMATAN MANDAU 598085 PT NAYAKA ERA

HUSADA PER/02/032015 RS.TRAUMA CENTRE 01/04/2016 31/12/2016

4 1500000000413 KLINIK NAYAKA HUSADA IIJALAN HANGTUAH RT 04 RW 01 DESA TAMBUSAI BATANG DUI KECAMATAN MANDAU

560757 PT NAYAKA ERA HUSADA


01/04/2016 31/12/2016

5 7-3273749957 KLINIK PRATAMA ADELIA MEDICAL

JL LINTAS PEKANBARU DURI PANGKALAN LIBUT PINGGIR

28784 TAUFIK 7-3273749957 RS.TRAUMA CENTRE

01/06/2016 31/12/2016

6 7-1704752493 KLINIK PRATAMA BERKAH JALAN LINTAS DURI – PEKANBARU DESA PINGGIR

28784 AFRIZAL TANJUNG 7-1704752493 RS.TRAUMA CENTRE 17/02/2016 31/12/2016

7 7-1704752493 KLINIK PRATAMA BERKAH JALAN LINTAS DURI – PEKANBARU DESA PINGGIR

28784 AFRIZAL TANJUNG 7-1704752493RS.TRAUMA CENTRE 02/02/2016 31/12/2016

8 1500000000411 KLINIK PRATAMA HAYATI JL DURI-DUMAI KM 16 DESA BONCAH MAHANG KECAMATAN MANDAU

71049091 RUSYDI PER/01/032015 RS.TRAUMA CENTRE

24/03/2016 31/12/2016

9 1500000000593 RSUD KECAMATAN MANDAU

JL. STADION NO. 10 DURI 7038918 RSUD KECAMATAN MANDAU


01/04/2016 31/12/2016

10 1400000000085RUMAH SAKIT PERMATA HATI

JL JEND. SUDIRMAN NO 37 KEL GAJAH SAKTI KEC MANDAU DURI 94902

PT. PERMATA HATI SUKSES MEDIKA PER/05/042015

RS.TRAUMA CENTRE 01/04/2016 31/12/2016

KANTOR CABANG : D06- KANTOR CABANG PEKANBARU PANAM


Periode : 01/01/2016 s/d 31/12/2016


43 / 15116-05-201607:59:01



IKS


1 7-2621518864 KLINIK FAMELA JAYA MEDIKA

JL KUBANG RAYA KEC. SIAK HULU KAMPAR 28471 MERI MURNIATI PER/04/032016 RS.TRAUMA

CENTRE 24/03/2016 20/03/2017

2 1500000000766 KLINIK KELUARGA SEHAT DOKTOR BASTIAN JL GARUDA SAKTI KM 2 7875077 DR ADOLF BASTIAN

TAMBUSAI.M.PD PER/09/052016 RS.TRAUMA CENTRE 11/05/2016 10/05/2017

3 7-2671295923 KLINIK PRATAMA DAREL MEDIKA

JL. SUKARNO HATTA NO 8C PEKANBARU 28282 DEFRI PER/03/032016 RS.TRAUMA CENTRE

24/03/2016 20/03/2017

4 7-2671295925 KLINIK PRATAMA DOKTER HARRY BARMA

JL RAYA PEKANBARU-BANGKINANG KM 39 28461 DR HARRY BARMA PER/05/032016 RS.TRAUMA CENTRE

24/03/2016 20/03/2017

5 1500000000538 KLINIK PRATAMA UWA MEDIKA

JL HR SUBRANTAS NO 92 A-C KEL SIMPANGBARU 7872833 DR DEFRI PER/02/032016 RS.TRAUMA

CENTRE 15/04/2016 14/04/2017

6 1500000000646 RS SURYA INSANI JL. DIPONEGORO KM 4 PASIR PENGARAIAN 7003404 PT.SURYA INSANI PER/06/042016RS.TRAUMA CENTRE 22/04/2016 21/04/2017

7 1400000000027 RUMAH SAKIT SANSANI JALAN SOEKARNO HATTA (ARENGKA ATAS) PEKANBARU

564666 SYAHRONI TUA PER/01/032016 RS.TRAUMA CENTRE

01/04/2016 31/03/2017

KANTOR CABANG : D07- KANTOR CABANG BATAM SEKUPANG


IKS


1 1400000000574KLINIK DUNIA MEDICAL CENTRE

RUKO FANINDO BLOK B NO 7-10 TJ UNCANG, BATU AJI-BATAM

3581242 DR KON SAN PER/04/022016RS.TRAUMA CENTRE

26/02/2016 31/01/2017

2 7-1265428985 KLINIK GLOBAL MEDICAL CENTRE

KOMP RUKO TAMAN LAGUNA BLOK A-2 NO 12 SEKUPANG BATAM

29428 07783582923

RIRIS LIANI PER/02/012016 RS.TRAUMA CENTRE

05/01/2016 03/01/2017


Periode : 01/01/2016 s/d 31/12/2016


44 / 15116-05-201607:59:01



IKS


3 1400000000255 KLINIK VELY KOMPLEK RUKO FANINDO BLOK A NO 12 A KEL TANJUNG UNCANG 9131737 DR. SITI VERA

NOTARINA PER/01/01/2016 RS.TRAUMA CENTRE 05/01/2016 03/02/2017

4 1400000000132 KLINIK YAHYA MEDICAL CENTER

RUKO SAGULUNG PERMAI BLOK B NO 14-15BATU AJI 29422 392748 SYARIEF A. FAHMI, ST PER/03/012016 RS.TRAUMA

CENTRE 05/01/2016 03/01/2017

KANTOR CABANG : E00- KANTOR CABANG JAMBI


IKS


1 1400000000559 RS BHAYANGKARA JAMBI JL RADEN MATTAHER NO 03 23246PER / 03 / 012016

RS.TRAUMA CENTRE 20/01/2016 30/11/2016

2 0700000000017 RS DR BRATANATA JL RD MATTAHER NO 33 20388 RS DR BRATANATA PER / 02 / 012016

RS.TRAUMA CENTRE

20/01/2016 31/12/2016

3 1400000000560 RS ROYAL PRIMA JAMBI JL RADEN WIJAYA RT 35 KEBON KOPI PER / 01 / 012016

RS.TRAUMA CENTRE

20/01/2016 30/11/2016

4 1400000000028 RSUD H ABDUL MANAPJL SK RD SYAHBUDDIN MAYANG MANGURAI 670455

PER / 06 / 012016

RS.TRAUMA CENTRE 29/04/2016 31/12/2016

KANTOR CABANG : E01- KANTOR CABANG MUARO BUNGO


IKS


1 7-2348650113 KLINIK RATU DUTA JL LINTAS SUMATERA KM 01 KEL PASAR SAROLANGUN

37481 INDRA GUNAWAN SE PER/01/032016 RS.TRAUMA CENTRE

22/03/2016 28/02/2017


Periode : 01/01/2016 s/d 31/12/2016


45 / 15116-05-201607:59:01



IKS


2 1400000000052 KLINIK SEHAT KELUARGA CERIA

JL LINTAS SUMATERAKM 15 ARAH PADANG RT 07 DUSUN EMBACANG GEDANG KEC TANAH SEPENGGAL LINTAS

M EFFENDI HARAHAP PER/ 03/ 032016 RS.TRAUMA CENTRE 01/04/2016 31/03/2017

3 1500000000297 RSU MAYJEN H.A THALIB (TC)

JL JEND BASUKI RAHMAT NO 1 SUNGAI PENUH - PROP JAMBI 21447 PEMDA KERINCI PER/08/102015 RS.TRAUMA

CENTRE 27/01/2016 30/09/2016

4 1400000000053 RSUD CHATIB QUZWAIN SAROLANGUN

JL. LINTAS SUMATERA KM.09 DESA BUKIT,SAROLANGUN

DR IRWAN MISWAR PER/01/032016 RS.TRAUMA CENTRE

11/05/2016 28/02/2017

KANTOR CABANG : G00- KANTOR CABANG PALEMBANG


IKS


1 1500000000183 RS MUHAMMADIYAH PALEMBANG

JL A. YANI RT.028 RW. 001 KELURAHAN 13 ULU KECAMATAN SEBRANG ULU II

513144 DR. H. YUDI FADILAH, SPPD, FINASIM


14/01/2016 31/12/2016

2 1400000000163 RS PELABUHAN PALEMBANG

JL MAYOR MEMET SASTRAWIRYA NO 01 BOOM BARU

712840 DR DEDY NUGROHO PER/01/012016 RS.TRAUMA CENTRE

20/01/2016 31/12/2017

3 1500000001101UPTD BLK INDUSTRI DISNAKERTRANS JL. RESIDEN H AMALUDDIN SAKO KENTEN PER/02/012016

RS.TRAUMA CENTRE 20/01/2016 31/12/2016

KANTOR CABANG : G02- KANTOR CABANG PANGKAL PINANG


IKS


1 1400000000730 BPRB MEDIKA STANNIA BELINYU YAYASAN BAKTI TIMAH PER/001/122015 RS.TRAUMA CENTRE

29/01/2016 29/02/2016


Periode : 01/01/2016 s/d 31/12/2016


46 / 15116-05-201607:59:01



IKS


2 1500000000133 KLINIK BAKTI TIMAH PARIT TIGA JL. RAYA PARIT TIGA 351143 YAYASAN BAKTI TIMAH PER/002/122015 RS.TRAUMA

CENTRE 29/01/2016 29/02/2016

3 1500000000130 KLINIK BAKTI TIMAH TANJUNGPANDAN JL. MELATI NO. 23 TANJUNGPANDAN 21865 YAYASAN BAKTI TIMAH PER/002/122015 RS.TRAUMA

CENTRE 29/01/2016 29/02/2016

4 1500000000131 KLINIK BAKTI TIMAH TOBOALI

JL. JEND. SUDIRMAN 227 TOBOALI 41771 YAYASAN BAKTI TIMAH PER/002/122015 RS.TRAUMA CENTRE

29/01/2016 29/02/2016

5 1500000000132 RS BAKTI TIMAH MUNTOK JL. RAYA TIMAH KOMPLEK PUSMET MUNTOK

21008 YAYASAN BAKTI TIMAH PER/002/122015 RS.TRAUMA CENTRE

29/01/2016 29/02/2016

6 1400000000299 RSUD KABUPATEN BANGKASELATAN 266656700 PER/09/052016 RS.TRAUMA

CENTRE 01/05/2016 30/01/2017

7 1400000000729RUMAH SAKIT MEDIKA STANNIA JL. JEND. SUDIRMAN NO. 03 SUNGAILIAT 95837 YAYASAN BAKTI TIMAH PER/001/122015

RS.TRAUMA CENTRE 29/01/2016 29/02/2016

KANTOR CABANG : G03- KANTOR CABANG MUARA ENIM


IKS


1 1500000001268BALAI LATIHAN KERJA KAB.MUARA ENIM JALAN PETROSIA III MUARA ENIM KAB MUARA ENIM PER/01/012016

RS.TRAUMA CENTRE 08/05/2016 28/01/2017

2 1500000001268BALAI LATIHAN KERJA KAB.MUARA ENIM

JALAN PETROSIA III MUARA ENIM KAB MUARA ENIM PER/01/012016RS.TRAUMA CENTRE

10/03/2016 28/01/2017

3 1500000001202 BALAI LATIHAN KERJA KOTA PRABUMULIH

JL JEND SUDIRMAN KM 35 320618 KOTA PRABUMULIH PER/42/062015 RS.TRAUMA CENTRE

10/03/2016 28/01/2017


Periode : 01/01/2016 s/d 31/12/2016


47 / 15116-05-201607:59:01



IKS


4 1500000000763 KLINIK FADHILAH PT TEL DI DESA NIRU KEC RAMBANG DANGKU 24102380 RS FADHILAH PER/28/042014 RS.TRAUMA

CENTRE 10/03/2016 25/01/2017

5 1500000000764 KLINIK FCM 24 JAM JL PADAT KARYA KELURAHAN GUNUNG IBUL 68044521 DR TRISNAYANTI PER/29/042015 RS.TRAUMA

CENTRE 10/03/2016 25/01/2017

6 7-3100567197 PUSKESMAS PULAU PANGGUNG

JL SERSAN M. BAHTIAR NO. 92, 31356 NURHAYANI PER/16/032016 RS.TRAUMA CENTRE

26/04/2016 01/03/2017

7 1500000001231 PUSKESMAS TANJUNG RAYA

DS TANJUNG RAYA KEC SEMENDO DARAT TENGAH

73720427 MUARA ENIM PER/45/062015 RS.TRAUMA CENTRE

17/03/2016 25/01/2017

8 1500000000599 RS AR BUNDA PRABUMULIH JL ANGKATAN 45 NO 525 KELURAHAN GUNUNG IBUL 322954 DR H ALIP YANSON PER/19/042015 RS.TRAUMA

CENTRE 10/03/2016 25/01/2017

9 1400000000192RS PERTAMINA PRABUMULIH

JL. KESEHATAN NO. 100 KOMPERTA PRABUMULIH 382742

PT. PERTAMINA BINA MEDIKA PER/21/04/2015

RS.TRAUMA CENTRE 05/04/2016 25/01/2017

10 1400000000122 RSUD HM RABAIN SULTAN MAHMUD BADARUDIN II NO. 49 424345 PER/12/012016 RS.TRAUMA CENTRE

10/03/2016 25/01/2017

11 1500000000640 RSUD PRABUMULIH JL LINGKAR KEL GUNUNG IBUL PRABUMULIH TIMUR

7001085 KOTA BRABUMULIH PER/26/042016 RS.TRAUMA CENTRE

10/03/2016 25/01/2017

12 1500000000691 RSUD TALANG UBIJL TAMAN SISWA KELURAHAN PASAR BHAYANGKARA, KECAMATAN TALANG UBI

390487PENUKAL ABAB LEMATANG ILIR PER/24/042015

RS.TRAUMA CENTRE 15/03/2016 25/01/2017

KANTOR CABANG : H00- KANTOR CABANG BANDAR LAMPUNG


Periode : 01/01/2016 s/d 31/12/2016


48 / 15116-05-201607:59:01



IKS


1 1400000000503 KLINIK KOSASIH AMANAH JL. IKAN KEMBUNG NO. 70 A TELUK BETUNG BANDAR LAMPUNG 35223 7175938 DR.S.TRI.HERLIANTO,SH,

MH,MM,MKES PER/25/112015 RS.TRAUMA CENTRE 04/01/2016 30/11/2016

2 1400000000500 KLINIK KOSASIH KEMILING JL. TEUKU CIK DITIRO BLOK E NO. 4 KEMILING BANDAR LAMPUNG 35158 3540424 DR.S.TRI.HERLIANTO,SH,


3 1400000000504 KLINIK KOSASIH PALAPA JL. CUT NYAK DIEN NO. 62 PALAPA BANDAR LAMPUNG

35116 7140218 DR.S.TRI.HERLIANTO,SH,MH,MM,MKES


04/01/2016 30/11/2016

4 1400000000507 KLINIK KOSASIH PANJANG JL. TANJUNG PURA II NO. 50 PANJANG UTARA BANDAR LAMPUNG

9761738 DR.S.TRI.HERLIANTO,SH,MH,MM,MKES


04/01/2016 30/11/2016

5 1400000000498 KLINIK KOSASIH SUMBER WARAS

JL. RAYA GADING REJO NO. 221 GADING REJO 7910645 DR.S.TRI.HERLIANTO,SH,


6 1400000000508KLINIK KOSASIH TANJUNGAN

JL. LINTAS SUMATERA SIMPANG KATES TANJUNG AGUNG LAMPUNG SELATAN 7773665

DR.S.TRI.HERLIANTO,SH,MH,MM,MKES PER/29/112015

RS.TRAUMA CENTRE 04/01/2016 30/11/2016

7 1400000000501 KLINIK KOSASIH TELUK JL. IKAN SALEM NO. 05 TELUK BETUNG BANDAR LAMPUNG



04/01/2016 30/11/2016

8 1400000000502 KLINIK KOSASIH TIRTAYASA

JL. PANGERAN TIRTAYASA NO. 181 SUKABUMI BANDAR LAMPUNG



04/01/2016 30/11/2016

9 1400000000499 KLINIK MITRA KOSASIHJL. MS. BATUBARA NO. 70 KUPANG TEBA TELUK BETUNG BANDAR LAMPUNG 7327768


RS.TRAUMA CENTRE 04/01/2016 30/11/2016

10 1400000000497KLINIK RAWAT INAP KOSASIH RAJABASA JL. KAPTEN ABDUL HAQ NO 9/31 RAJABASA 7511491


RS.TRAUMA CENTRE 04/01/2016 30/11/2016

11 1400000000505KLINIK RAWAT INAP KOSASIH TUGU

JL. KAPTEN HAYAM WURUK NO. 20 TANJUNG KARANG TIMUR

7365397DR.S.TRI.HERLIANTO,SH,MH,MM,MKES


04/01/2016 30/11/2016

12 1400000000496 KLINIK RAWAT INAP KOSASIH URIP

JL URIP SUMOHARJO NO 176 KEDATON 3526413 DR.S.TRI.HERLIANTO,SH,MH,MM,MKES


04/01/2016 30/11/2016


Periode : 01/01/2016 s/d 31/12/2016


49 / 15116-05-201607:59:01



IKS


13 1500000000181 RS GLADISH MEDICAL CENTER

JL. RAYA AHMAD YANI NO.36 RT 01 RW 01 DESA TAMAN SARI KEC. GEDONG TATAAN KAB. PESAWARAN

CV GLADISH MEDICAL CENTER PER/04/022016 RS.TRAUMA

CENTRE 10/02/2016 31/01/2017

14 1500000000253 RS MUHAMMADIYAH METRO

JL. SOEKARNO HATTA NO. 42 MULYOJATI 16 B KEC. METRO BARAT KOTA METRO 7008000 PERSYARIKATAN

MUHAMMADIYAH PER/09/022016 RS.TRAUMA CENTRE 28/03/2016 28/02/2017

15 1500000000209 RS NATAR MEDIKA JL. RAYA NATAR NOMOR 4 MUARA PUTIH 92521 YAYASAN ABDI KARYA PER/05/022016 RS.TRAUMA CENTRE

10/02/2016 31/01/2017

16 1500000000218 RS TINGKAT IV 02.07.04 (RS DKT) BANDAR LAMPUNG

JL. KAPT. A RIVAI 7 PENENGAHAN TANJUNG KARANG PUSAT


28/03/2016 28/02/2017

17 1400000000116 RS URIP SUMOHARJO JL URIP SUMOHARJO NO 200 SUKARAME 771322 PT GUNUNG SULAH MEDIKA PER/07/022016 RS.TRAUMA

CENTRE 16/03/2016 28/02/2017

18 1500000000115 RS WISMA RINI JL. WISMA RINI NO. 01 PRINGSEWU 21582YAYASAN BUDI SETIA BHAKTI PER/01/022016

RS.TRAUMA CENTRE 10/02/2016 31/01/2017

19 1500000000165RSUD DR. H. ABDUL MOELOEK PROVINSI LAMPUNG

JALAN DR. RIVAI NOMOR 06 PENENGAHAN 703312 PROVINSI LAMPUNG PER/05/012015 RS.TRAUMA CENTRE

10/02/2016 31/01/2017

20 1400000000471 RSUD DR. H. BOB BAZAR, SKM

JALAN LETTU ROHANI NOMOR 14B KALIANDA


04/01/2016 30/11/2016

21 1500000000134 RSUD PESAWARANJL. RAYA KEDONDONG DESA WAY LAYAP KEC. GEDONG TATAAN

KABUPATEN PESAWARAN PER/02/022016

RS.TRAUMA CENTRE 16/02/2016 31/01/2017


KABUPATEN PESAWARAN PER/03/012015

RS.TRAUMA CENTRE 10/02/2016 31/01/2016


KABUPATEN PESAWARAN


10/02/2016 31/01/2017

24 1500000000427 UPTD BALAI LATIHAN KERJA BANDAR LAMPUNG

JL. PAGAR ALAM NOMOR 127 BANDAR LAMPUNG

DINAS TENAGA KERJA DAN TRANSMIGRASI PROVINSI LAMPUNG


28/03/2016 28/02/2017


Periode : 01/01/2016 s/d 31/12/2016


50 / 15116-05-201607:59:01


KANTOR CABANG : H01- KANTOR CABANG LAMPUNG TENGAH


IKS


1 7-2738805337KLINIK PRATAMA RAWAT INAP PT. GREAT GIANT PINEAPPLE

KAMPUNG TERBANGGI BESAR KM 77 KEC. TERBANGGI BESAR

34163 PT. GREAT GIANT PINEAPPLE


06/04/2016 19/01/2017

2 1500000000318 RS ISLAM ASY-SYIFAA JL. LINTAS SUMATRA KM 65 BANDAR JAYA 34163 DR. JOSI HARNOS PER/004/032016 RS.TRAUMA CENTRE 07/03/2016 01/03/2017

3 7-1568007187 RS YUKUM MEDICAL CENTRE

JL. NEGARA NO. 99 KM 67 YUKUM JAYA KEC. TERBANGGI BESAR 34163 072525333 PT. MITRA MEDICAL

CENTER PER/002/012016 RS.TRAUMA CENTRE 22/02/2016 31/01/2017

KANTOR CABANG : J00- KANTOR CABANG JAKARTA SALEMBA


IKS


1 1500000001278 KLINIK PERTAMEDIKAJL. PERWIRA NO.2-4 KEL. GAMBIR KEC. GAMBIR JAKARTA PUSAT DR NENY HERAWATI PER/84/042016

RS.TRAUMA CENTRE 13/05/2016 31/03/2017

2 1400000000304 KLINIK SUMBER SEHATJL. PERCETAKAN NEGARA 2 BLOK J NO. 14-15, KELURAHAN JOHAR BARU

4240700 DR EDI SETIAWAN PER/03/012016RS.TRAUMA CENTRE

28/03/2016 31/12/2016

3 1500000000328 RS MH THAMRIN SALEMBA JALAN SALEMBA TENGAH NO 24 -28 JAKARTA PUSAT

DR MIRA ROZIATI DACHLAN


20/04/2016 28/02/2017

4 1400000000298 RS PERTAMINA JAYA JL.JEND.ACHMAD YANI NO 2 CEMPAKA PUTIH


05/01/2016 31/12/2016

5 1400000000658 RS RIDWAN MAUREKSA PER/62/122015RS.TRAUMA CENTRE 14/03/2016 30/11/2016

6 1400000000351 RSIA EVASARIJL. RAWAMANGUN NO. 27 PRAMUKA JAKARTA PUSAT 10570 4202851 PER/02/012016

RS.TRAUMA CENTRE 05/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


51 / 15116-05-201607:59:01


KANTOR CABANG : J02- KANTOR CABANG JAKARTA GROGOL


IKS


1 7-2354876841 RSTC DUTA INDAH JL TELUK GONG RAYA NO 12 14450 66676188 PT DUTA INDAH MEDIKA PER/05/032016 RS.TRAUMA CENTRE

07/03/2016 28/02/2017

2 1500000000516 RSTC MEDIKA PERMATA HIJAU

JL RAYA KEBAYORAN LAMA NO.64 JAKARTA BARAT 5347411 PER/07/032016 RS.TRAUMA

CENTRE 14/03/2016 28/02/2017

3 1500000000088 RSTC ROYAL TARUMA JL DAAN MOGOT NO 34 JAKARTA 56967788 DR. LIMAN HARIJONO, MARS PER/06/032016 RS.TRAUMA

CENTRE 14/03/2016 28/02/2017

4 7-2617918393 RSTC SUMBER WARAS JL KYAI TAPA NO.1 TOMANG, GROGOL PETAMBURAN, JAKARTA BARAT 11440 021-

5682011YAYASAN RS SUMBER WARAS PER/04/032016 RS.TRAUMA

CENTRE 22/03/2016 28/02/2017

KANTOR CABANG : J03- KANTOR CABANG JAKARTA KELAPA GADING


IKS


1 7-2942035683RUMAH SAKIT PELABUHAN JAKARTA

JL.KRAMAT JAYA TANJUNG PRIOK 14310DR.M.SYAIFUL HUDA EFFENDI,M.M


15/04/2016 30/11/2016

2 7-2307624884 RUMAH SAKIT SATYA NEGARA

JALAN AGUNG UTARA RAYA BLOK A NO.1 JAKARTA UTARA

14350 64715200 DR. SANTOSO KURNIAWAN


29/02/2016 30/04/2016

KANTOR CABANG : J04- KANTOR CABANG JAKARTA RAWAMANGUN


Periode : 01/01/2016 s/d 31/12/2016


52 / 15116-05-201607:59:01



IKS


1 7-1669163483 RSTC OMNI PULOMAS JL. PULOMAS BARAT VI NO.20, JAKARTA TIMUR 13210 2977 9999 DR MARIA PER/01/012016 RS.TRAUMA

CENTRE 01/02/2016 31/01/2017

KANTOR CABANG : J06- KANTOR CABANG JAKARTA CILANDAK


IKS


1 1500000000170 KLINIK ARAS JL SRENGSENG SAWAH RT 001/009 JAGAKARSA 7869916 DR. SERI ANNI

NASUTION PER/01/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

2 1500000000839 PPKD JAKARTA SELATAN JL BUNCIT RAYA NO 440 MAMPANG 7980311 LETTY LESTARI PER/03/052016RS.TRAUMA CENTRE 02/05/2016 31/07/2016

3 1500000001524 RS FATMAWATI DI JL RS FATMAWATI CILANDAK 7501524 DR.ANDI WAHYUNINGSIH ATTAS


28/04/2016 30/04/2016

4 1500000001524 RS FATMAWATI DI JL RS FATMAWATI CILANDAK 7501524 DR.ANDI WAHYUNINGSIH ATTAS


02/05/2016 31/07/2016

5 1500000000721 RS MAYAPADAJL LEBAK BULUS I KAV 20 CILANDAK JAKARTA SELATAN 29217777 RS MAYAPADA PER/01/052016

RS.TRAUMA CENTRE 02/05/2016 31/07/2016

6 1500000000721 RS MAYAPADAJL LEBAK BULUS I KAV 20 CILANDAK JAKARTA SELATAN 29217777 RS MAYAPADA PER/10/052015

RS.TRAUMA CENTRE 28/04/2016 30/04/2016

7 7-3320778960 RS SETIA MITRA JL RS FATMAWATI NO 80-82 12790 DR SARASWATI PER/05/052016RS.TRAUMA CENTRE

20/05/2016 20/04/2018

KANTOR CABANG : J07- KANTOR CABANG JAKARTA GAMBIR


Periode : 01/01/2016 s/d 31/12/2016


53 / 15116-05-201607:59:01



IKS


1 7-2457507777 RS TARAKAN JL. KYAI CARINGIN NO.7 JAKARTA PUSAT 10150 3503150-000

DR. TOGI ASMAN SINAGA MKES PER/02/2016 RS.TRAUMA

CENTRE 14/03/2016 31/12/2017

2 1500000001453 RUMAH SAKIT HUSADA JLN. RAYA MANGGA BESAR NO.137-139 JAKARTA PUSAT 10730 6260108 PER/10/062016 RS.TRAUMA

CENTRE 01/06/2016 31/05/2017

KANTOR CABANG : J09- KANTOR CABANG JAKARTA CAWANG


IKS


1 7-3145572913 KLINIK YADIKA CIBUBURJL. LAPANGAN TEMBAK NO. 09 RT. 001/ 007, CIBUBUR, JAKARTA TIMUR 13740 DR. NOVITA DJUNAEDI PER/03/042016

RS.TRAUMA CENTRE 13/05/2016 30/04/2018

2 7-2448782290 RSUD BUDHI ASIH JALAN DEWI SARTIKA CAWANG III NO. 200 JAKARTA TIMUR

13630 DR. IDA BAGUS NYOMANBANJAR, MKM


08/03/2016 31/12/2016

KANTOR CABANG : J0P- KANTOR CABANG JAKARTA SLIPI


IKS


1 1400000000303 RS PELNI JL AIPDA KS TUBUN 92-94 10210 5485870 PT PELNI PER/09/092015RS.TRAUMA CENTRE

27/01/2016 31/12/2016

KANTOR CABANG : J11- KANTOR CABANG TANGERANG BATUCEPER


Periode : 01/01/2016 s/d 31/12/2016


54 / 15116-05-201607:59:01



IKS


1 1500000000145 KLINIK PRATAMA MH THAMRIN CENGKARENG

JL DAAN MOGOT KM 17 NO 69 RT02/04 KLDRS PER/003/012016 RS.TRAUMA

CENTRE 01/02/2016 31/01/2017

2 7-2709100583 KLINIK SEMANAN JL SEMANAN RAYA NO 23 RT 001/002 11720 DR JOHAN PER/008/032016 RS.TRAUMA CENTRE 01/04/2016 31/03/2017

3 7-1459450363 RS HERMINA DAAN MOGOT JL KINTAMANI RAYA NO 2 DAAN MOGOT BARU

11710 DR I ICHSAN HANAFI MARS


22/01/2016 17/01/2017

4 1500000000146 RS KARANG TENGAH MEDIKA

JL KARYAWAN IV CILEDUG KARANG TENGAH


01/02/2016 31/01/2017

5 1500000001260 RS MITRA HUSADA JL KAMPUNG MELAYU BARAT NO 11 A TELUK NAGA

082125449938 DR HENDRY WIJAYA PER/014/052016 RS.TRAUMA

CENTRE 02/05/2016 30/04/2017

6 7-3175908453RSK DR SITANALA TANGERANG JL DR SITANALA NO 99 KOTA TANGERANG 15211

DR ALI MUCHTAR SP PK MARS PER/013/052016

RS.TRAUMA CENTRE 02/05/2016 30/04/2017

KANTOR CABANG : J12- KANTOR CABANG JAKARTA PULOGADUNG


IKS


1 1500000000247 RS ANTAM MEDIKA JL RAYA PEMUDA NO 1A 29378939 PER /08/032016RS.TRAUMA CENTRE 15/03/2016 28/02/2018

KANTOR CABANG : J13- KANTOR CABANG JAKARTA KEBAYORAN BARU


Periode : 01/01/2016 s/d 31/12/2016


55 / 15116-05-201607:59:01



IKS


1 1500000000476 RS GANDARIA JLN GANDARIA TENGAH II NO 6-14 JAK SEL 7203311 DR .H.J ROESLANI S,SP THT PER/01/042016 RS.TRAUMA

CENTRE 20/04/2016 31/03/2017

KANTOR CABANG : J17- KANTOR CABANG JAKARTA MAMPANG


IKS


1 1806201500004 RS ZAHIRAH JL. SIRSAK NO.21 JAGAKARSA JAKARTA SELATAN 7872210 ROBI HARI

SETIAWAN,SE,MM PER/04/032016 RS.TRAUMA CENTRE 01/06/2016 30/04/2017

KANTOR CABANG : K00- KANTOR CABANG BANDUNG SUCI


IKS


1 1500000001896 BIOFIT HEALTH CENTER JL. WR SUPRATMAN NO. 69, BANDUNG 40114 7271451 NENDEN SUHARTINI PER/01/012016RS.TRAUMA CENTRE 04/01/2016 31/12/2016

2 1500000000837 KLINIK KIMIA FARMA 14 JL. CIHAMPELAS 7 BANDUNG 4201596PT KIMIA FARMA (PERSERO) TBK PER/09/012016

RS.TRAUMA CENTRE 04/01/2016 31/12/2016

3 1500000000834 KLINIK KIMIA FARMA 51 JL.IR.H.JUANDA 69 BANDUNG 4203331PT KIMIA FARMA (PERSERO) TBK


04/01/2016 31/12/2016

4 1500000000835 KLINIK KIMIA FARMA SETIABUDI

JL.SETIABUDI 36 BANDUNG 2038048 PT KIMIA FARMA (PERSERO) TBK


04/01/2016 31/12/2016

5 1500000000836 KLINIK KIMIA FARMA SINDANGLAYA

JL. SUKAMISKIN 126B BANDUNG 7178664 PT KIMIA FARMA (PERSERO) TBK


04/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


56 / 15116-05-201607:59:01



IKS


6 1500000000859 KLINIK ALIVIA MEDIKA JL. PASUNDAN NO. 107, BANDUNG 87805328 YUDI PRIHARTANTO PER/02/012016 RS.TRAUMA CENTRE 04/01/2016 31/12/2016

7 1500000000860 KLINIK AMANAH JL. PHH MUSTOFA NO. 124, BANDUNG. 7279705 YUDI PRIHARTANTO PER/03/012016 RS.TRAUMA CENTRE 04/01/2016 31/12/2016

8 1500000000805 KLINIK BINA MASYARAKAT SEHAT (BMS)

JL. AH NASUTION NO. 96 A BANDUNG 7801861 DR H YONO SUDIYONO MARS, MHKES


01/01/2016 31/12/2016

9 1500000000855 KLINIK HIKMAHJL. PESANTREN NO. 8A, RT 01/04, KELURAHAN SUKAMISKIN, KECAMATAN ARCAMANIK, BANDUNG

814 254 80 DRG NIA LESTARI PER/05/012016 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

10 1500000000854 KLINIK HIKMAH DUA JL. IBRAHIM AJI NO. 145, KIARA CONDONG, BANDUNG 81525480 NANO ROHANA PER/06/012016 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

11 1500000000585 KLINIK ITENAS JALAN PHH MUSTOFA NO. 23 , BANDUNG PT. RS PADJADJARAN PER/07/012016RS.TRAUMA CENTRE 04/01/2016 31/12/2016

12 1500000000584 KLINIK KIARA HUSADA JALAN IBRAHIM ADJIE NO. 25 (TERS KIRCON) BANDUNG

7564929 PT RUMAH SAKIT PADJADJARAN


04/01/2016 31/12/2016

13 1500000000833 KLINIK KIMIA FARMA 43 JL. BUAH BATU 59 BANDUNG 7305019 PT KIMIA FARMA (PERSERO) TBK


04/01/2016 31/12/2016

14 1500000000553 KLINIK MITRA MULYAJL. AH NASUTION NO. 20 RT 001/014, CIPADUNG KIDUL, PANYILEUKAN, BANDUNG

7804489 MULYATI PER/14/012016RS.TRAUMA CENTRE 04/01/2016 31/12/2016

15 1500000000704 KLINIK PRATAMA SEHATIRUKO BUMI MAS KENCANA KAV O. JL. AH NASUTION 928, CIKADUT, BANDUNG 7237337

DRG YUDHIASTUTI NUNING HARINI PER/15/012016

RS.TRAUMA CENTRE 04/01/2016 31/12/2016

16 1500000000600 KLINIK PRATAMA SELAMATJL. TERUSAN BUAH BATU NO. 227 BANDUNG

88881585 DR MAGDALIZA PER/16/012016RS.TRAUMA CENTRE

04/01/2016 31/12/2016

17 1500000000853 KLINIK UJUNG BERUNG JL. RUMAH SAKIT NO.5 RT. 006/07, PAKEMITAN, CINAMBO, BANDUNG

91752269 DR HARIS FATAH PER/17/012016 RS.TRAUMA CENTRE

04/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


57 / 15116-05-201607:59:01



IKS


18 1500000000743 KLINIK UTAMA AL ISLAM JL. AWIBITUNG NO. 29-31 CICADAS BANDUNG 7208284

YAYASAN RUMAH SAKITISLAM-KSWI JAWA BARAT


19 1500000000708 KLINIK UTAMA MEDIKA ANTAPANI

JALAN PURWAKARTA NO.3 ANTAPANI BANDUNG

081563944143 DRA HJ LENTE MELANIE PER/19/012016 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

20 1500000000801 RS MATA CICENDO JL. CICENDO NO. 4 BANDUNG 4231280 KEMENKES PER/20/012016 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

21 1100000000014 RS PINDAD JL. GATOT SUBROTO NO.517 PAPANGGUNGAN BANDUNG


04/01/2016 31/12/2016

22 1100000000015 RS SARININGSIH JL. LL RE MARTADINATA NO. 9 PER/22/012016 RS.TRAUMA CENTRE 04/01/2016 31/12/2016

23 1500000001399 RS. SALAMUNJL. CIUMBELUIT NO. 203, BANDUNG, JAWA BARAT, 40142 2032090

DR. BAMBANG S. GUNADI, SP.RAD., MARS., PER/23/012016

RS.TRAUMA CENTRE 04/01/2016 31/12/2016

24 1500000001934 RSKB HALMAHERA SIAGA JL.L.L.R.E.MARTADINATA NO.28, JAWA BARAT 40115

40115 4206061 PROF DR M AHMAD DJOJOSUGITO, DR, SP OT


04/01/2016 31/12/2016

25 1500000000697 RSU BUNGSU JL. VETERAN NO. 6, BANDUNG 4231550 DR. LILIAN MELATTIE E. NORE


04/01/2016 31/12/2016

26 7-2299406693 RSU HERMINA ARCAMANIKJL. A H NASUTION NO. 50 BANDUNG, JAWA BARAT, 40291 40291 87242525 DR. TOMMY JOESOEF PER/25/012016

RS.TRAUMA CENTRE 01/03/2016 31/12/2016

27 1500000000460 RSUD KOTA BANDUNG JL. RUMAH SAKIT NO. 22, UJUNGBERUNG 7811794 PER/26/012016RS.TRAUMA CENTRE 04/01/2016 31/12/2016

28 1500000001936RSUP HASAN SADIKIN BANDUNG

JL. RAYA PASTEUR NO 36, BANDUNG 40161 2034953 KEMENKES PER/27/012016RS.TRAUMA CENTRE

04/01/2016 31/12/2016

KANTOR CABANG : K01- KANTOR CABANG BEKASI KOTA


Periode : 01/01/2016 s/d 31/12/2016


58 / 15116-05-201607:59:01



IKS


1 1500000000698 KLINIIK TC ANNISA JL RAYA KAMPUNG BARU KEMANG RT 03/04 JATIBENING BARU PD GEDE BEKASI PER/17/052015 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

2 1500000000830 KLINIK TC CAHAYA ASYPA TAMAN NAROGONG INDAH BLOK C.18 NO 1 ALAN PER/24/052015 RS.TRAUMA CENTRE 04/01/2016 31/12/2016

3 1500000000699 KLINIK TC HANDAYANI MEDIKA

JL RAYA KALIMALANG NO 9 DS CIBUNTU CIBITUNG BEKASI


04/01/2016 31/12/2016

4 1500000000744 KLINIK TC MAHADINA JL RAYA SELANG JATI RT 03/03 WANAJAYACIBITUNG


04/01/2016 31/12/2016

5 1500000000913 KLINIK TC MH THAMRIN BEKASI

JL HM JOYOMARTONO NO 31B BEKASI TIMUR PER/25/052015 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

6 1500000001328 KLINIK TC SETO HASBADI 01JL SEROJA NO 10A KA CEGER RT 06/02 HARAPAN JAYA PER/30A/062015

RS.TRAUMA CENTRE 04/01/2016 31/12/2016

7 1500000001327 KLINIK TC SETO HASBADI 02 JL RAYA SULTAN AGUNG BLOK O NO 27 MEDAN SATRIA

PER/30B/062015 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

8 1500000001326 KLINIK TC SETO HASBADI 06 JL RAYA IMAM BONJOL NO 01 TELAGA ASIH CIKARANG BARAT

PER/30C/062015 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

9 1500000001254 KLINIK TC SRITINAJL IMAM BONJOL NO 8 RT 01/01 TELAGA MURNI CIKARANG BARAT PER/28/062015

RS.TRAUMA CENTRE 04/01/2016 31/12/2016

10 7-3241314323 RS ANNA MEDIKAJL RAYA PERJUANGAN NO 45 HARAPAN BARU BEKASI 17121 88882211 PT ANNA MEDIKA PER/05/052016

RS.TRAUMA CENTRE 11/05/2016 31/12/2016

11 1400000000121 RSTC CIBITUNG MEDIKA J LRAYA BOSIH NO.117 CIBITUNG 88323444 PT ADHI PUTRA MEDIKA PER/01/012016RS.TRAUMA CENTRE

09/02/2016 31/12/2016

12 1400000000121 RSTC CIBITUNG MEDIKA J LRAYA BOSIH NO.117 CIBITUNG 88323444 PT ADHI PUTRA MEDIKA PER/19/052015 RS.TRAUMA CENTRE

04/01/2016 31/12/2015


Periode : 01/01/2016 s/d 31/12/2016


59 / 15116-05-201607:59:01



IKS


13 1100000000020 RSTC HOSANA MEDICA JL PRAMUKA NO.12 RAWA LUMBU NAROGONG 8221570 JOHANES POSO PER/27/062015 RS.TRAUMA

CENTRE 04/01/2016 31/12/2015

14 1100000000020 RSTC HOSANA MEDICA JL PRAMUKA NO.12 RAWA LUMBU NAROGONG 8221570 JOHANES POSO PER/02/012016 RS.TRAUMA

CENTRE 09/02/2016 31/12/2016

KANTOR CABANG : K02- KANTOR CABANG BOGOR KOTA


IKS


1 1500000000252 BATIK MEDICAL CENTERJL KAYUMANIS NO 09 RT 02/ 01 KEL CIBINONG 295333182

CV BATIK ESTETIKA INDONESIA PER/16/012016

RS.TRAUMA CENTRE 25/01/2016 31/12/2016

2 1400000000415 BP BUNDA MULIA JL SOMANTRI NO 11 RT 003/004 DS MEKAR MULYA PARUNG PANJANG

5978058 HJ UPEN SUPENTI PER/07/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

3 1500000000073 BP NURDIN WAHID JL HM ASHARI NO 22 CIBINONG 87916739 YANNI MAUTIA S R PER/12/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

4 7-1588689223 KLINIK AULIA MEDIKA JL.LANDBAW NO.01 16810 87902900 SUSINAH HARUN PER/22/012016RS.TRAUMA CENTRE 04/02/2016 31/12/2016

5 7-1588689227 KLINIK MH THAMRIN JL.RAYA PUNCAK KM 75 CIPAYUNG 1677002518256172 YAYASAN MH THAMRIN PER/25/012016

RS.TRAUMA CENTRE 04/02/2016 31/12/2016

6 1400000000311KLINIK PELITA SEHAT SIMPANG POMAD

JL RAYA CIBULUH NO 8-9 KEL CIBULUH KEC KOTA BOGOR UTARA

DR JUNAIDY FREDY PER/23/012016RS.TRAUMA CENTRE

29/01/2016 31/12/2016

7 7-1670259391 KLINIK PERMATA HUSADA JL.RAYA BABAKAN MADANG NO.10 16810 87952811 DRG.WIWIK DWI ARYANI, MARS


04/02/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


60 / 15116-05-201607:59:01



IKS


8 1500000001536 PUSKESMAS JASINGA JL.LET.SAYUTI JASINGA 085780041002 PER/21/012016 RS.TRAUMA

CENTRE 25/01/2016 31/12/2016

9 1400000000310 RS ATANG SANJAYA JL SARIJO NO 1 ATANG SANJAYA KEMANG 7532946 AURI PER/04/012016 RS.TRAUMA CENTRE 25/01/2016 31/12/2016

10 1500000000314 RS BHAYANGKARA TK IV BOGOR

JALAN KAPTEN MUSLIHAT NO 18 8348987 POLRI PER/17/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

11 1200000000006 RS BINA HUSADA TC JL MAYOR OKING JAYAATMAJA 87911000 DR HARSONO PER/01/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

12 1500000000071 RS FAMILY MEDICAL CENTER TC

JL RAYA JAKARTA BOGOR KM 51 SUKARAJA

PT JALAMAS PUTRA REJEKI PER/10/012016 RS.TRAUMA

CENTRE 25/01/2016 31/12/2016

13 1400000000286 RS ISLAM BOGOR JALAN PERDANA RAYA NO 22 8316822 YYS RS ISLAM BOGOR PER/26/012016RS.TRAUMA CENTRE 29/01/2016 31/12/2016

14 1400000000284 RS KARYA BHAKTI PRATIWI JALAN RAYA DRAMAGA KM 7 8626868 YYS KARYA BHAKTI PRATIWI


25/01/2016 31/12/2016

15 1400000000713 RS MELANIA JALAN PAHLAWAN NO 91 BOGOR SELATAN 8321196 PT SPAA MEDIKA PER/09/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

16 1500000000074 RS PMI BOGOR TC JL PAJAJARAN NO 80 YAYASAN PMI PER/13/012016RS.TRAUMA CENTRE 25/01/2016 31/12/2016

17 1400000000309 RS SALAK BOGOR JL JENDRAL SUDIRMAN NO 8 8344609 KESDAM SILIWANGI PER/03/012016RS.TRAUMA CENTRE 25/01/2016 31/12/2016

18 1500000000072RS SENTRA MEDIKA CIBINONG TC

JL MAYOR OKING JAYAATMAJA 87909999 DRG HERMAN PER/11/012016RS.TRAUMA CENTRE

25/01/2016 31/12/2016

19 1400000000333 RS TRIMITRA JL RAYA JAKARTA BOGOR KM 43 CIBINONG

8763055 DR EMA SUMARSAH PER/05/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


61 / 15116-05-201607:59:01



IKS


20 1500000000637 RS VANIA JL SILIWANGI NO 11 KEL SUKASARI BOGORTIMUR PER/19/012016 RS.TRAUMA

CENTRE 25/01/2016 31/12/2016

21 1500000000075 RSD CIBINONG TC JL DESA TENGAH NO 27 CIBINONG PEMDA KAB BOGOR PER/14/012016 RS.TRAUMA CENTRE 25/01/2016 31/12/2016

22 1500000000636 RSIA ANNISA JL RAYA KARANGGAN NO 2 DS PUSPASARI CITEUREUP

YYS ANNISA PER/18/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

23 1500000001535 RSUD CIAWI BOGOR JL.RAYA PUNCAK NO.479 CIAWI 08121101284


25/01/2016 31/12/2016

24 1400000000442 RSUD KOTA BOGOR JALAN RAYA SUMERU NO 120 DR TRIWANDHA ELAN PER/08/012016 RS.TRAUMA CENTRE 25/01/2016 31/12/2016

25 1500000000230RUMAH SAKIT PERTAMEDIKA SENTUL CITY

JL MH THAMRIN NO.1 SENTUL CITY BOGOR 29672977 KWEE LIANA KUMALA PER/15/012016RS.TRAUMA CENTRE 25/01/2016 31/12/2016

26 1400000000414 SALSABILLA MEDICAL CENTRE

JL KSR DADI KUSMAYADI RUKO LMC NO 70CIKARET CIBINONG

87905768 DR WAHYU EKO W, SPOT PER/06/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

KANTOR CABANG : K04- KANTOR CABANG TANGERANG CIKOKOL


IKS


1 1500000001159MAYAPADA HOSPITAL TANGERANG

JL. HONORIS RAYA KAV. 6, KOTA MODERN TANGERANG

55781888DR. DEDI TEDJAKUSNADI, MARS


01/01/2016 31/12/2016

2 1400000000650 RS BHAKTI ASIH JL RADEN SALEH NO 10 KARANG TENGAH TANGERANG

7305662 YAYASAN BHAKTI ASIH PER/67/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


62 / 15116-05-201607:59:01



IKS


3 1400000000652 RS. SARI ASIH CILEDUG JL HOS COKROAMINOTO NO 38 CILEDUG 7333430PT. SARI ASIH PUTRA MANDIRI, DICKY R H PAMUNGKAS


4 1400000000651 RS. SARI ASIH KARAWACI JL. IMAM BONJOL NO.38 5522794PT. SARI ASIH PUTRA MANDIRI, DICKY R H PAMUNGKAS


5 1400000000655 RS. SILOAM HOSPITALS LIPPO VILLAGE

JL. SILOAM NO 6 LIPPO VILLAGE TANGERANG

5460055PT. SILOAM INTERNATIONAL HOSPITALS


04/01/2016 31/12/2016

6 1500000000465 RS. USADA INSANI JL. K.H HASYM ASHARI NO. 24 TANGERANG 55752575 PT. SURYA MITRA INSANI


01/01/2016 31/12/2016

7 1500000000017 RSU KABUPATEN TANGERANG

JL JEND AHMAD YANI NO 9 TANGERANG 15111 5523507 PEMDA KABUPATEN

TANGERANG PER/73/122015 RS.TRAUMA CENTRE 19/04/2016 31/12/2016

KANTOR CABANG : K05- KANTOR CABANG SERANG


IKS


1 1500000000330 BP PERMATA HUSADA JL LETJEND SUPRAPTO NO 45 CILEGON WAWAN MULYANA PER/07/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

2 1500000001467KLINIK DJASARI MEDIKA CURUG

KP.TINGGAR RT 03/02 DS.SUKALAKSANA KEC.CURUG

085254259386 DRG. DIAN KIBLATI PER/078/062015

RS.TRAUMA CENTRE 01/05/2016 31/05/2016

3 1500000000331 KLINIK ISNA MEDIKAJL RAYA MERAK KM 8 NO.1 LINK KESERANGAN RAWAARUM

573756 DR ISNAYATI PER/08/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

4 1500000000254 KLINIK MEDIKA JL JEND AHAMD YANI NO.56 209975 DR. DIANAHAN PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


63 / 15116-05-201607:59:01



IKS


5 1500000000107 KLINIK MODERN MEDIKA CIKANDE

RUKO B6 KOMP MODERN INDUSTRI CIKANDE JL RAYA SERANG KM 68 400554 PT MODERN MEDIKA PER/03/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

6 1500000000255 KLINIK SERANG MEDIKA JL RAYA SERANG CILEGON RUKO LEGOK SUKMAJAYA BLOK 5C NO. 1 223992 DR RINA NOVIA SP.AN PER/06/032015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

7 1500000000329 RS HERMINA CIRUAS JL RAYA SERANG JAKARTA KM 9 CIRUAS 280555 HERMINA HOSPITAL GROUP


01/01/2016 31/12/2016

8 7-3071694287 RS KRAKATAU MEDIKA JL SEMANG RAYA 42415 0254397456

PT KRAKATAU MEDIKA PER/03/022016 RS.TRAUMA CENTRE

26/04/2016 31/01/2017

9 1500000000086 RS SARI ASIH SERANG JL JEND SUDIRMAN NO 38 SERANG 220022 PT SARI ASIH ARIA CEMERLANG PER/01/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

10 1400000000082 RSUD BANTEN JL SYECH NAWAWI AL-BANTANI 8490911 PROVINSI BANTEN PER/010/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

11 1500000000244 RSUD DR. ADJIDARMO JL IKO DJATMIKO NO.1 RANGKASBITUNG 376433 RSUD ADJIDARMO PER/04/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

12 1400000000320 RSUD SERANG JL RUMAH SAKIT NO.1 42111 200528 KOTA SERANG PER/02/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

KANTOR CABANG : K06- KANTOR CABANG SUKABUMI


IKS


1 1500000000059 RS BETHA MEDIKA JL. RAYA CISAAT NO. 595 224128 PER/14/TC/12/2015

RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


64 / 15116-05-201607:59:01



IKS


2 1400000000196 RS BHAKTI MEDICARE JL. RAYA SILIWANGI NO. 186 B, CICURUG, KAB SUKABUMI 731555 SUPRIADI SETIAWAN PER/03/TC/0420

16RS.TRAUMA CENTRE 01/05/2016 30/04/2018

3 1400000000531 RS KARTIKA MEDICAL CENTER JL. JEND. A. YANI NO 18A 6250902 PER/02/TC/0420

16RS.TRAUMA CENTRE 04/04/2016 30/11/2017

4 1400000000671 RSUD CIMACAN JL. RAYA CIMACAN NO. 17 CIPANAS 512465 PER/15/TC/122015

RS.TRAUMA CENTRE

01/01/2016 31/12/2016

5 1500000000060 RSUD PELABUHAN RATU JL. A. YANI NO. 2 PELABUHAN RATU PER/20/TC/122015

RS.TRAUMA CENTRE

01/01/2016 31/12/2016

6 1500000000515 RSUD R. SYAMSUDIN SH JL. RUMAH SAKIT NO. 1 PER/01/TC/042016

RS.TRAUMA CENTRE 04/04/2016 31/03/2017

7 1500000000428RUMKITBAN 03.08.01 PANGRANGO JL. PGRI NO 8

PER/04/TC/042016

RS.TRAUMA CENTRE 04/04/2016 31/03/2018

KANTOR CABANG : K07- KANTOR CABANG TASIKMALAYA


IKS


1 1400000000593RUMAH SAKIT JASA KARTINI JL OTTO ISKANDARDINATA NO. 15 331808

PT. KARSA ABDI HUSADA PER/68/122015

RS.TRAUMA CENTRE 09/02/2016 31/12/2016

KANTOR CABANG : K09- KANTOR CABANG PURWAKARTA


Periode : 01/01/2016 s/d 31/12/2016


65 / 15116-05-201607:59:01



IKS


1 1300000000035 RS. MH THAMRIN PURWAKARTA JL. RAYA BUNGURSARI NO. 36 SADANG 8222222

DR.H. KEMAL MUHAMAD, MMR.,M.KES,AIFO


2 1400000000434 RSUD BAYU ASIH JL VETERAN NO 39 PER/20/102015 RS.TRAUMA CENTRE 21/01/2016 31/10/2016

KANTOR CABANG : K10- KANTOR CABANG KARAWANG


IKS


1 1500000001517KLINIK GRAHA MEDIS CILAMAYA

JL RAYA CILAMAYA DESA CILAMAYA WETAN KAB KARAWANG 340202

DR H. SUNUHARDO EP, M.KES PER/11/012016

RS.TRAUMA CENTRE 12/01/2016 31/12/2016

2 1500000000409 KLINIK BHAKTI MEDIKA JL AHMAD YANI NO 100 DAWUAN CIKAMPEK

8862936 MUHAMMAD SAFI'I MA'ARIF ,SE


12/01/2016 31/12/2016

3 1500000000847 KLINIK BINA MEDIKA JL RAYA TELUK JAMBE NO 5 DESA TELUK JAMBE

641968 SUDIARTO (08121918055) PER/16/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

4 7-1372189411 KLINIK CURUG RAHAYU KP KARAJAN 2 DS CURUG KEC KLARI 41371 MARANTINO LUMMUSA PER/24/012016RS.TRAUMA CENTRE 12/01/2016 31/12/2016

5 1500000000846 KLINIK GEMPOLJL RANGGA GEDE NO 29 GEMPOL KEL TANJUNG PURA KEC KARAWANG BARAT

0267-8453903 SUDIARTO (08121918055) PER/17/012016

RS.TRAUMA CENTRE 12/01/2016 31/12/2016

6 1500000001515KLINIK GRAHA MEDIS CIKAMPEK

JL A. YANI NO 51 DAWUAN TIMUR 310101DR. HJ. DYAH PERMATA S.M.KES


12/01/2016 31/12/2016

7 1500000001516 KLINIK GRAHA MEDIS KOPEL

JL RAYA KLARI DS KLAPANUNGGAL RT 26/07 GINTUNG KERTA KLARI

DR H DYAH PERMATA SURYARINI M.KES


12/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


66 / 15116-05-201607:59:01



IKS


8 1500000001518 KLINIK GRAHA MEDIS KOSAMBI

JL RAYA KOSAMBI NO 23 DESA DUREN KLARI 435527 DR.H. SUNUHARDO EP,

M.KES PER/14/012016 RS.TRAUMA CENTRE 12/01/2016 31/12/2016

9 1500000000843 KLINIK MITRA GEMPOL JL PROKLAMASI NO 15 KW 8 RT 003/005 KELTUNGGAK JATI KEC KARAWANG BARAT 483749 SUDIARTO (08121918055) PER/18/012016 RS.TRAUMA

CENTRE 12/01/2016 31/12/2016

10 01019 KLINIK MITRA SEHAT JL. RAYA KOSAMBI CURUG NO 28 KARAWANG

433930 DR. YUNITA PUSPITASARI


12/01/2016 31/12/2016

11 1500000000463 KLINIK NAYAKA JL TUPAREV NO 334 B DAN C KARAWANG 418430 PENDI SUPENSI PER/20/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

12 1500000000848 KLINIK PURWA MEDIKA JL RAYA TAMELANG NO 53 DESA MEKARJAYA KEC. PURWASARI 433653 SUDIARTO (08121918055) PER/21/012016 RS.TRAUMA

CENTRE 12/01/2016 31/12/2016

13 1500000001948 KLINIK SATRIA MEKARJL PANGKALAN LOJI DESA TAMAN MEKAR KEC. PANGKALAN 41311

085624943888 YAYAT SALEH PER/25/012016

RS.TRAUMA CENTRE 12/01/2016 31/12/2016

14 1500000000407 KLINIK YAKESTI JL RAYA KLARI RT 01/02 GINTUNG KERTA KLARI KARAWANG

432416 MUHAMMAD SAFEI'I MA'ARIF


12/01/2016 31/12/2016

15 1500000001714 KLINIK YASMIN JL IR H JUANDA KM2 KOTA BARU RT 02/05 41311 SAFRINA DEWI PER/23/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

16 1500000000849 LIRA MEDIKA JL SYECH QURO NO 14 PALUMBONSARI 8452555NY ANGELIAQUE ARYANTO PER/09/012016

RS.TRAUMA CENTRE 12/01/2016 31/12/2016

17 7-1272337870 RS BAYU KARTA JL. KERTABUMI NO 44 KARAWANG 413110267401818 DR WHISNU SANTOSO PER/01/012016

RS.TRAUMA CENTRE 06/01/2016 31/12/2016

18 7-1122449393 RS CITO JL. ARTERI TOL KARAWANG BARAT 41312 HAJI GANGGA ENDANG PER/03/012016RS.TRAUMA CENTRE

05/01/2016 31/12/2016

19 1400000000368 RS CITRA SARI HUSADA JL RAYA KOSAMBI TELAGASARI KM 3 KLARI

437507 ADE RELAWATI PER/05/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


67 / 15116-05-201607:59:01



IKS


20 1500000001708 RS DELIMA ASIH SISMA MEDIKA

JL WIRASABA NO 54 JOHAR KEC KARAWANG TIMUR 41311 403073 PT DELIMA SISMA

MEDIKA PER/04/012016 RS.TRAUMA CENTRE 12/01/2016 31/12/2016

21 1400000000349 RS ISLAM KARAWANG JL. PANGKAL PERJUANGAN KM. 2 PER/06/012016 RS.TRAUMA CENTRE 12/01/2016 31/12/2016

22 1500000000408 RS IZZA JL RAYA CISELANG DESA CIKAMPEK UTARA KECAMATAN KOTA BARU

8386830DR MED H LUQMAN ADJISAPTOGINO, SP RAD (K) DAN SP KN


12/01/2016 31/12/2016

23 1400000000348 RS KARYA HUSADA JL. JEND. AHMAD YANI NO. 98 CIKAMPEK KARAWANG


12/01/2016 31/12/2016

24 1400000000347 RS PURI ASIH JATISARI JL. RAYA JATISARI NO. 3 MEKARSARI JATISARI DR AKID PER/10/012016 RS.TRAUMA

CENTRE 12/01/2016 31/12/2016

25 7-2322882543 RS ROSELAJL. INTERCHANGE NO 3 TOL KARAWANG BARAT DS WADAS 41311

DR YESI KARYA LIANTI, MARS PER/26/032015

RS.TRAUMA CENTRE 02/03/2016 31/12/2016

26 06823 RSU DELIMA ASIH SISMA MEDIKA

JL WIRASABA NO 54 JOHAR 403073 PER/04/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

27 7-1277095197 RUMAH SAKIT FIKRI MEDIKA

JL. RAYA KOSAMBI TELAGASARI KM 3 41314 H SAEPUDIN PER/02/012015 RS.TRAUMA CENTRE

05/01/2016 30/06/2016

KANTOR CABANG : K11- KANTOR CABANG CIMAHI


IKS


1 1500000000232 KLINIK NAYAKA ERA HUSADA

JL. JEND. H. AMIR MACHMUD NO 477 CIBABAT CIMAHI

6640384PT NAYAKA ERA HUSADA CABANG CIMAHI


22/04/2016 28/02/2017


Periode : 01/01/2016 s/d 31/12/2016


68 / 15116-05-201607:59:01



IKS


2 1500000000233 KLINIK PRATAMA SEHAT BUDI LUHUR JL. KERKOF NO 32 CIMAHI SELATAN 6674146 KLINIK SEHAT BUDI

LUHUR PER/01/022016 RS.TRAUMA CENTRE 22/04/2016 28/02/2017

3 1500000000234 KLINIK WIJAYA MEDIKA JL. RAYA CIBURUY NO 684 PADALARANG 6806125 KLINIK WIJAYA MEDIKA PER/03/022016 RS.TRAUMA CENTRE 22/04/2016 28/02/2017

KANTOR CABANG : K12- KANTOR CABANG SUMEDANG


IKS


1 1500000000499 KLINIK CAHAYA QALBU JL. RAYA LASWI NO.480 CIKOPO, CIPARAY 85963355DR HERVI NURYANIA MEGA REZA PER/13/032016

RS.TRAUMA CENTRE 11/05/2016 01/03/2017

2 1500000000482 KLINIK MEDIKA PRATAMA II

JL. RAYA BANDUNG GARUT NO.24 BOJONGLOA, RANCAEKEK

7537511 LULU FOTUANA PER/15/032016 RS.TRAUMA CENTRE

11/05/2016 01/03/2017

3 1500000000483 KLINIK MEDIKA PRATAMA III

JL. RAYA BANJARAN NO.564, BOJONGMANGGU, PAMEUNGPEUK

7537511 LULU FOTUANA PER/16/032016 RS.TRAUMA CENTRE

11/05/2016 01/03/2017

4 1500000000489 KLINIK NAYAKA HUSADA 05JL. MOH. TOHA PALASARI , DAYEUH KOLOT

085106398668

PT. NAYAKA ERA HUSADA PER/11/032016

RS.TRAUMA CENTRE 11/05/2016 01/03/2017

5 1500000000488 KLINIK NAYAKA HUSADA 07 JL. BALEKAMBANG SUKAMAJU MAJALAYA082318663334

PT. NAYAKA ERA HUSADA PER/12/032016

RS.TRAUMA CENTRE 11/05/2016 01/03/2017

6 1500000000492 KLINIK RATNASARI SEHATJL. SOREANG BANJARAN, CILUNCAT, CANGKUANG

08120605293

DR. RATNA SARIHARYANTI


11/05/2016 01/03/2017

7 0900000000038 RS AMC (TRAUMA CENTRE) JL. RAYA CILEUNYI RANCAEKEK 7781630 PT. ANISSA EKA UTAMA PER/07/012016 RS.TRAUMA CENTRE

11/05/2016 01/01/2017


Periode : 01/01/2016 s/d 31/12/2016


69 / 15116-05-201607:59:01



IKS


8 1500000000505 RSUD KABUPATEN SUMEDANG JL. P GEUSAN ULUN NO.41 7217744 PEMDA JAWA BARAT PER/09/012016 RS.TRAUMA

CENTRE 19/04/2016 31/12/2016

KANTOR CABANG : K13- KANTOR CABANG TANGERANG CIKUPA


IKS


1 1500000001507 KLINIK BHAKTI MULYA KRONJO

JL.RAYA KRONJO NO.6 DESA PASILIAN KRONJO DR.A GHOFIR PKS/31/122015 RS.TRAUMA

CENTRE 11/01/2016 31/12/2016

2 1500000001506 KLINIK BKKM BANTENJL RAYA SERANG KM.31 SUMUR BANDUNG JAYANTI

DR.H.A DRAJAT A.P MKES PKS/33/122015

RS.TRAUMA CENTRE 11/01/2016 31/12/2016

3 1500000001513 KLINIK CITRA INSANI MARDI GRAS RUKO KF02/05 CITRA RAYA CIKUPA

DR SABRI PKS/32/122015 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

4 1500000001314 KLINIK MILENIA SEJAHTERA 1 TIGARAKSA

JL MILENIUM RAYA 1A /A11 18-19 TIGARAKSA

29006869 PKS/28/122015 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

5 1500000001309KLINIK MILENIA SEJAHTERA 2 BALARAJA

RUKO ULITMATE BLOK A1-2 JL RAYA SERANG KM24 BALARAJA 29015571 PKS/29/122015

RS.TRAUMA CENTRE 11/01/2016 31/12/2016

6 1500000001512 KLINIK MULYA RAHAYU JL. PLP LEGOK ASEM NO.124 LEGOK HJ SRI LIS RAHAYU PKS/30/122015RS.TRAUMA CENTRE 11/01/2016 31/12/2016

7 1500000001508 KLINIK PRIMA MEDIKAJL. RAYA SERANG KM.14,8 KOMP RUKO B/16 CIKUPA

MUSAFAH PKS/34/122015RS.TRAUMA CENTRE

11/01/2016 31/12/2016

8 1500000001510 KLINIK PRIMA SENTUL JL. RAYA SERANG KM.24 A/11 SENTUL BALARAJA

MUSAFAH PKS/35/122015 RS.TRAUMA CENTRE

11/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


70 / 15116-05-201607:59:01



IKS


9 1500000001504 KLINIK UMUM & BERSALIN YULISATI JL. RAYA SERANG KM 36 JAYANTI 10/03 DR. MAWARDI LUBIS PKS/36/122015 RS.TRAUMA

CENTRE 11/01/2016 31/12/2016

KANTOR CABANG : K14- KANTOR CABANG BEKASI CIKARANG


IKS


1 1400000000549 KLINIK GRAHA BINA HUSADA

JL.INDUSTRI SELATAN NO.1A, BLOK NN-3AJABABEKA II, CIKARANG BARU 89836243 PT.GRAHA BINA HUSADA PER/54/122015 RS.TRAUMA

CENTRE 05/01/2016 30/11/2016

2 7-1254255963KLINIK KASIH ANUGERAH SERANG BARU

JL. RAYA CIBARUSAH, KP.BUNISARI RT.007/004, DESA SUKARAGAM, KEC. SERANG BARU , KABUPATEN BEKASI

17530DR KETTLER SIAHAAN, MBA PER/58/122015

RS.TRAUMA CENTRE 04/01/2016 04/11/2016

3 7-1251921754 RS AMANDA JALAN RAYA SERANG , NO. 83 CIKARANG 17530 DR.HAMIDAH, M.KES PER/60/122015 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

4 7-1432249443 RS ANNISA CIKARANG JL CIKARANG BARU, NO.31, KECAMATAN CIKARANG UTARA, KAB.BEKASI

17530 DR.NOOR ARIDA SOFIANA, MBA


18/01/2016 31/12/2016

5 7-2767325803 RS APRILIA MEDIKADI JALAN RAYA SETU NO.99, DESA LUBANGBUAYA , KEC SETU, KAB. BEKASI, 17530 DR LENI ASTUTI , DR PER/11/032016

RS.TRAUMA CENTRE 01/04/2016 31/03/2017

6 1400000000055 RS BHAKTI HUSADAJL.R.E.MARTADINATA BY PASS CIKARANG-BEKASI 89110896

PT HUSADA PURWAKARTA PER/10/032016

RS.TRAUMA CENTRE 01/04/2016 31/03/2017

7 7-1254255965 RS DR SANDER.BJL. KH.DEWANTARA NO.33 CIKARANG UTARA, KABUPATEN BEKASI

17340 DR. HASAN PER/59/122015RS.TRAUMA CENTRE

05/01/2016 30/11/2016

8 7-1250333673 RS HOSANA LIPPO CIKARANG

JL UTAMA BIIE ,NO. 01, LIPPO CIKARANG BEKASI

17530 JOHANNES POSO PER/56/122015 RS.TRAUMA CENTRE

04/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


71 / 15116-05-201607:59:01



IKS


9 1500000000495 RS MEDIROSSA JL INDUSTRI TEGAL GEDE NO.9, CIKARANGSELATAN 89833216 PT MEDIROSSA MITRA

INSANI PER / 07 /032016 RS.TRAUMA CENTRE 01/04/2016 31/03/2017

10 1300000000022 RS. PERMATA KELUARGA JL.M.H. THAMRIN KAV 129 LIPPO CIKARANG 89905588 PER/08/032016 RS.TRAUMA

CENTRE 01/04/2016 31/03/2017

KANTOR CABANG : K15- KANTOR CABANG BANDUNG LODAYA


IKS


1 1500000000873 KLINIK ALBARJL TERUSAN KOPO NO 371 KOPO MARGAHAYU 40225

085863333599 YAYASAN LESTARI PER/14/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

2 1400000000252 KLINIK AVIATI KOPO JL KOPO NO. 59 PANJUNAN - KOTA BANDUNG

40241 5232291 PT. AVIATI PRIMA CITRA PER/09/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

3 1500000001810 KLINIK BHAYANGKARA HUSADA POLRES BANDUNG

JL. BHAYANGKARA NO. 1 POLRES BANDUNG - SOREANG

40911 85871980 POLRES BANDUNG PER/16/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

4 1500000001538KLINIK INSANIYAH MEDICAL CENTRE

JL TERUSAN AL FATHU KM 17 RT 05 RW 04 DESA PAMEKARAN SOREANG 40911 85874343 PMI KAB BANDUNG PER/17/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

5 1500000001541 KLINIK KATAPANGJL TERUSAN KOPO NO 65 KATAPANG-SOREANG 40921 21175677 DR.FELIX KASIM, M.KES PER/18/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

6 1500000001537KLINIK LUHUR MEDICA CENTRE

JL JEND SUDIRMAN NO 472/474 ANDIR - BANDUNG

40182 6037679CV LUHUR MEDICA CENTRE


01/01/2016 31/12/2016

7 1400000000251 KLINIK NAYAKA HUSADA 04 JL TERUSAN KOPO KM 12 KATAPANG KAB. BANDUNG

40921 61804614 PT. NAYAKA ERA HUSADA


01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


72 / 15116-05-201607:59:01



IKS


8 1500000000871 KLINIK NORMA MASITHA JL RAYA TIMUR NO 41 BANJARAN KAB BANDUNG 40377 5944144 DR HJ ROSIDAH AGUS PER/11/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

9 1500000000911 KLINIK RATNASARI 2 JL RAYA CIWIDEY KP PEER RT 03 RW 23 DESA CIWIDEY KEC CIWIDEY 40973 5927794 APENG HIDAYAT PER/13/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

10 1500000000872 KLINIK SAHABAT SEHAT AMPUH

JL TERUSAN KOPO NO 593 KM 11,5 DS PANGAUBAN KATAPANG

40921 5897000 DRS AHMAD SUHANDA PER/10/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

11 1500000000882 KLINIK SEHAT MEDIKA UTAMA

JL PANGALENGAN SITU CILEUNCA KP SIDAMUKTI RT 01 RW 04 PANGALENGAN

40378 081320605293

APENG HIDAYAT PER/12/2016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

12 1500000001330 KLINIK SEHAT SEJAHTERA JL LAMAJANG NO.119 DAYEUHKOLOT 40238 5204139 DR RUKHIYAT SYAHIDIN PER/07/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

13 1500000001709 KLINIK WIDYA BHAKTI INTI JL. MOCH TOHA NO.77 BANDUNG 40253 5201501 PT.WIDYA BHAKTI INTI PER/15/012016RS.TRAUMA CENTRE 01/01/2016 31/01/2016

14 1400000000080 RSUD AL IHSAN PROV. JABAR

JL KIASTRAMANGGALA - BALEENDAH 40258 5940872 PEMDA PROVINSI JABAR PER/02/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

15 1100000000025 RUMAH SAKIT IMMANUEL JL. KOPO NO 161 KOTA BANDUNG 40241 5201051 YAYASAN BRS GK PASUNDAN


01/01/2016 31/12/2016

16 1500000001540RUMAH SAKIT UMUM DAERAH SOREANG JL ALUN ALUN UTARA NO 1 SOREANG 40911 5891355

PEMERINTAH DAERAH KAB. BANDUNG PER/05/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

17 1500000001715SANTOSA HOSPITAL BANDUNG CENTRAL JL KEBONJATI NO 38 BANDUNG 40181 4248555

PT SANBE PRAKARSA HUSADA PER/04/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

18 1500000001388SANTOSA HOSPITAL BANDUNG KOPO

KH. WAHID HASYIM NO 461- 463 KOPO BANDUNG

40221 54280555PT SANBE PRAKARSA HUSADA


01/01/2016 31/12/2016

KANTOR CABANG : K16- KANTOR CABANG BOGOR CILEUNGSI


Periode : 01/01/2016 s/d 31/12/2016


73 / 15116-05-201607:59:01



IKS


1 1500000001174 KLINIK ANGGI KP CIBEBER DS KAHURIPAN KLAPANUNGGAL 29219678 YAYASAN NOGI SEHATI PER/04/012016 RS.TRAUMA

CENTRE 25/01/2016 31/12/2016

2 1500000001514 KLINIK DERA ASSYIFA JL RAYA NAROGONG KM 23 DESA CILEUNGSI 8234492 PT. DURASTIKA SOMA

WIJAYA PER/09/012016 RS.TRAUMA CENTRE 25/01/2016 31/12/2016

3 1500000001382 KLINIK DR IRMAN PERUM GRIYA ALAM SENTOSA BLOK C9 NO 4 RT 10/08 PASIRANGIN CILEUNGSI

YAYASAN SUMARNO MEDIKA


25/01/2016 31/12/2016

4 1500000001207 KLINIK DR. MARZUKI JL RAYA CILEUNGSI JONGGOL KM 2,2 DR MARZUKI PER/05/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

5 7-1552354085 KLINIK EDELWEISSPERUMAHAN CITRA GRAND CIBUBUR RUKO CITYWALK 2 NO 1-2 JATI KARYA SAMPURNA BEKASI

16820 DR AFRIYANTI SANDHI PER/12/012016 RS.TRAUMA CENTRE 25/01/2016 31/12/2016

6 1500000001690 KLINIK EKA MEDIKAJL RAYA NAROGONG NO 116 KLAPANUNGGAL 16820 29289475

DR HARUMITI RAMIL,MKK PER/11/012016

RS.TRAUMA CENTRE 25/01/2016 31/12/2016

7 1500000001687 KLINIK GRACIA JL RAYA NAROGONG KM 17 DESA CILEUNGSI

16820 SURYATI SARI ARUM, SKOM


25/01/2016 31/12/2016

8 1500000001331 KLINIK MH THAMRIN MEKARSARI

RUKO EBONY BLOK 23 RT 006/004 DESA CILEUNGSI

8235052 DR RISKA ARISKA YULIANTI


25/01/2016 31/12/2016

9 1500000001383KLINIK PKO MUHAMMADIYAH

PERUM PTSC JL ANGGREK BLOK A NO 12 KEC CILEUNGSI DR NUR CAHYANINGSIH PER/07/012016

RS.TRAUMA CENTRE 25/01/2016 31/12/2016

10 1500000001691 RS HERMINA MEKARSARI JL RAYA CILEUNGSI JONGGOL KM 1 16820 29232525 VIVI FRIYATNI, SKM PER/01/012016RS.TRAUMA CENTRE 25/01/2016 31/12/2016

11 1500000001927 RS PERMATA JONGGOLJL RAYA JONGGOL NO 1 A SUKAMANAH JONGGOL

16120 89931333DR EVY FEBRINA NURPENI, MARS


25/01/2016 31/12/2016

12 1400000000327 RSTC MH THAMRIN CILEUNGSI

JL RAYA NAROGONG KM 16 LIMUSNUNGGAL CILEUNGSI

8235052 DR ABDUL RADJAK PER/02/012016 RS.TRAUMA CENTRE

21/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


74 / 15116-05-201607:59:01



IKS


13 1500000000590 TC RSIA KENARI GRAHA MEDIKA

GRIYA KENARI MAS BLOK B2 CILEUNGSI BOGOR 8230426 DRA FATIMAH PER/15/032016 RS.TRAUMA

CENTRE 11/05/2016 31/12/2016

KANTOR CABANG : K17- KANTOR CABANG TANGERANG CIMONE


IKS


1 7-3271915318 KLINIK GEBANG MEDIKAJL PRABU KIAN SANTANG NO 30 RT 001 RW 001 KEL GEBANG RAYA KEC PERIUK KOTA TANGERANG

15131 55773345 DRA PUJI WAHYUNI PER / 09 / 042016

RS.TRAUMA CENTRE 10/05/2016 31/03/2017

2 1500000000649 RS DINDA GALUH NO 2 JATIUWUNG 15133 PT DINDA MEDISTRA PER/04/042016RS.TRAUMA CENTRE 26/01/2016 31/12/2016

3 1500000000649 RS DINDA GALUH NO 2 JATIUWUNG 15133 PT DINDA MEDISTRA PER/04/012016 RS.TRAUMA CENTRE

26/01/2016 31/12/2016

4 1100000000004 RSU AN NISA JL GATOT SUBROTO NO 96 KM 3, CIBODAS 5525564 DR EDIANSYAH, MARS PER/05/2016 RS.TRAUMA CENTRE

27/01/2016 31/12/2016

5 1100000000005 RSU ARIYA MEDIKAJL INDUSTRI RAYA I BLOK A NO.1-10 JATAKE 5902226 DR E TRISNO SUSILO PER/06/022016

RS.TRAUMA CENTRE 12/02/2016 31/01/2017

KANTOR CABANG : K18- KANTOR CABANG DEPOK


IKS


1 1500000001929 KLINIK BHAKTI JAYA JL. KARTINI - CITAYAM RAYA NO.18 A 16411 77203062 DRG.SRI SULISWATI,MM PER/32/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


75 / 15116-05-201607:59:01



IKS


2 1500000001808 KLINIK IRENK MEDIKA JL BAHAGIA RAYA NO 18 DEPOK TIMUR 16413 7715039 ARUJI AMBAR SUKOCO, SE PER/31/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

3 1500000001922 KLINIK YANI MEDIKA JL KARTINI NO 48 RT.03/09 KEL DEPOK KEC PANCORAN MAS 16414 77219553 DR YANI HARYANI PER/33/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

4 1500000001971 PRAKTEK DR MAS'UD JL CINERE RAYA PERUMAHAN GRIYA CINERE 2 KAV 48 NO 12A LIMO

16421 7533780 DR. MAS'UD PER/34/122015 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

5 1400000000184 RS BHAKTI YUDHA JL RAYA SAWANGAN NO 2A DEPOK 16511 7520082 THAMAS INVESTAMA GUNA


04/01/2016 31/12/2016

6 1400000000183 RS BHAYANGKARA SIKESJAS KORBRIMOB JL RAYA AKSES UI KELAPA DUA DEPOK 87704691 DR TAUFIK PER/26/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

7 1400000000528 RS CITRA MEDIKA DEPOKJL.RAYA KALIMULYA NO.68 CILODONG KOTA KEMBANG DEPOK 29671000 DR NENCY PER/28/122015

RS.TRAUMA CENTRE 04/01/2016 31/12/2016

8 7-2718973400 RS HERMINA DEPOK JL RAYA SILIWANGI NO 50 PANCORAN MASDEPOK

16431 77202525 PT MEDIKALOKA HUSADA


04/04/2016 31/12/2016

9 1500000001916 RS PERMATA DEPOK JL RAYA MUCHTAR NO.22 SAWANGAN DEPOK

16511 29669000 PT MUFIDAH MEDIKA SAWANGAN


04/01/2016 31/12/2016

10 1400000000181RS SENTRA MEDIKA CISALAK

JL RAYA JAKARTA BOGOR KM 33 CISALAK DEPOK 8743790

DR HERMAN WIDYATOMO PER/22/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

11 1400000000182 RS SIMPANGAN DEPOKJL RAYA JAKARTA BOGOR KM 36 SUKAMAJU DEPOK D WARSITO PER/24/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

12 1400000000180 RS TUGU IBUJL RAYA JAKARTA BOGOR KM 29 CIMANGGIS DEPOK

8710870 H MARIS RINALDI PER/23/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

13 1400000000285 RSTC GRHA PERMATA IBU JL KH USMAN NO 168 BEJI KUKUSAN DEPOK

7778899 DR PARAMITA PER/25/122015 RS.TRAUMA CENTRE

04/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


76 / 15116-05-201607:59:01


KANTOR CABANG : K19- KANTOR CABANG TANGERANG BSD


IKS


1 1500000000448 KLINIK AMIRA GRIYA LOKA BSD TANGSEL DR MURTININGRUM PER/04/042016 RS.TRAUMA CENTRE

01/04/2016 31/03/2017

2 1500000000621 KLINIK DIANA PERMATA MEDIKA

JL MH. THAMRIN KAV. 888C PANUNGGANGAN PINANG 5397314 DR. HJ. DIANA

FACHRUDIN PER/05/042016 RS.TRAUMA CENTRE 01/04/2016 31/03/2017

3 1500000000323 KLINIK DR RANNY JL BUARAN RAYA RT 003/001 SERPONG 75874222 PER/06/042016 RS.TRAUMA CENTRE 01/04/2016 31/03/2017

4 1500000000441 KLINIK MAKMUR JAYA JL CEGER RAYA - PONDOK AREN DR AYAT RAHAYU SP.RAD. MKES PER/07/042016 RS.TRAUMA

CENTRE 01/04/2016 31/03/2017

5 1500000000440 KLINIK MAKMUR JAYA I - CIPUTAT

CIPUTAT TIMUR DR AYAT RAHAYU SP.RAD. M.KES


01/04/2016 31/03/2017

6 1500000000442 KLINIK MAKMUR JAYA II - PAMULANG CIPUTAT TIMUR DR AYAT RAHAYU

SP.RAD MKES PER/09/042016 RS.TRAUMA CENTRE 01/04/2016 31/03/2017

7 1500000000443 KLINIK SURADITAJL WIJAYA KUSUMA RAYA 10 - 11 PERUMNAS SURADITA DR HJ SITI MURWANI PER/10/042016

RS.TRAUMA CENTRE 01/04/2016 31/03/2017

8 7-1679975283 RS OMNI ALAM SUTERAJL ALAM SUTERA BOULEVARD KAV 25 SERPONG

15325 53125555PT SARANA MEDITAMA INTERNATIONAL


01/02/2016 31/01/2017

9 1400000000079 RS PERMATA PAMULANG JL RAYA SILIWANGI NO 1A PAMULANG 74704999 DR TAUFIK ZAIN SPOG (K)


02/05/2016 30/04/2017

KANTOR CABANG : L00- KANTOR CABANG SEMARANG PEMUDA


Periode : 01/01/2016 s/d 31/12/2016


77 / 15116-05-201607:59:01



IKS


1 7-1435412603 PUSKESMAS BRATI JL. RAYA KUDUS KRONGGEN PURWODADI NO. 20, KEC. BRATI 58153 085290455

655 MURSIYATI, SKM PER/22-1/112015 RS.TRAUMA CENTRE 15/01/2016 31/12/2016

2 7-1435686266 PUSKESMAS GABUS I JL. TAMAN SARI DS. SULUSARI, KEC. GABUS 58183 SOEPARNO, SKM PER/22-2/112015 RS.TRAUMA

CENTRE 15/01/2016 31/12/2016

3 7-1435751247 PUSKESMAS GABUS II JL SADANG DS. KARANGREJO, KEC. GABUS 58183 TOTOK EKO SUBANDRIYO, SKM

PER/22-3/112015 RS.TRAUMA CENTRE

15/01/2016 31/12/2016

4 7-1435773598 PUSKESMAS GEYER I JL. RAYA SOLO PURWADADI, KEC. GEYER 58172 00551107 DR. AGUNG PROBO M, M.SI


15/01/2016 31/12/2016

5 7-1435791349 PUSKESMAS GEYER II DS. BANGSRI, KEC. GEYER 58172 EDI SUCIPTO, S.KEP.M.KES PER/22-5/112015 RS.TRAUMA

CENTRE 15/01/2016 31/12/2016

6 7-1444349893 PUSKESMAS GODONG I JL. RAYA SEMARANG, KEC. GODONG 581620292659322 DR. WIWIK WIBAWA PER/22-6/112015

RS.TRAUMA CENTRE 18/01/2016 31/12/2016

7 7-1444478904 PUSKESMAS GODONG II DS. SAMBUNG, KEC. GODONG 58162 DRG. SISWANTO HANANTA


18/01/2016 31/12/2016

8 7-1444574355 PUSKESMAS GROBOGAN JL. PUGER NO.160, KEC. GROBOGAN 58152 02927703006

DR. AGUS BUDIYANTO PER/22-8/112015 RS.TRAUMA CENTRE

18/01/2016 31/12/2016

9 7-1444762696 PUSKESMAS GUBUG I JL. A. YANI 119, KEC. GUBUG 581640292533326 DR. ARIEF GUNAWAN PER/22-9/112015

RS.TRAUMA CENTRE 18/01/2016 31/12/2016

10 7-1444853077 PUSKESMAS GUBUG IIJL. RAYA PILANG JEKETRO KM. 7, KEC.GUBUG 58164

029251353488 DR. SUWINDI

PER/22-10/112015

RS.TRAUMA CENTRE 18/01/2016 31/12/2016

11 7-1444951638PUSKESMAS KARANGRAYUNG I

JL. GONDONG JUWANGI, KEC. KARANGRAYUNG

58163AGUNG DWI SUJATMOKO, SKM

PER/22-11/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

12 7-1445380831 PUSKESMAS KARANGRAYUNG II

JL. RAYA TELAWAH, KEC. KARANGRAYUNG

58163 PUJIYONO, SKM,M.KES PER/22-12/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


78 / 15116-05-201607:59:01



IKS


13 7-1445437092 PUSKESMAS KEDUNGJATI JL. RAYA KEDUNGJATI, KEC. KEDUNGJATI 58167 0292658088 DR. HARDJOKO PER/22-

13/112015RS.TRAUMA CENTRE 18/01/2016 31/12/2016

14 7-1445504163 PUSKESMAS KLAMBU DS. KLAMBU, KEC. KLAMBU 58154 081575586160 SIGIT TYASMONO, SKM PER/22-

14/112015RS.TRAUMA CENTRE 18/01/2016 31/12/2016

15 7-1445537804 PUSKESMAS KRADENAN I JL. SURYOJENGGOLO 16 KUWU, KEC. KRADENAN

58182 0292761241

DR. YATINO PER/22-15/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

16 7-1445609485 PUSKESMAS KRADENAN II JL. HONGGO KUSUMAN 13, KEC KRADENAN 58182 0292761577

SUBANDI, SKM PER/22-16/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

17 7-1445738346 PUSKESMAS NGARINGAN JL. RAYA BLORA, KEC. NGARINGAN 58193 081225177040

M. ABDUL RAUF, S.KEP, M.KES

PER/22-17/112015

RS.TRAUMA CENTRE 18/01/2016 31/12/2016

18 7-1445782077PUSKESMAS PENAWANGAN I

JL. RAYA PURWODADI, KEC. PENAWANGAN 58161

02924271070

DR. DIANA FAJAR UDHARITA

PER/22-18/112015

RS.TRAUMA CENTRE 18/01/2016 31/12/2016

19 7-1445869188 PUSKESMAS PENAWANGAN II

JL. RAYA SEDADI KM 3, KEC. PENAWANGAN

58161 DR. AGUS BUDI SARJONO, MM

PER/22-19/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

20 7-1445943179 PUSKESMAS PULOKULON I JL. RAYA . PANUNGGALAN NO 137, KEC. PULOKULON

58181 081325129862

RIJADI AZIKIN, SKM, M.KES

PER/22-20/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

21 7-1445969030 PUSKESMAS PULOKULON IIJL. DAYANG KUWU NO.18, KEC. PULOKULON 58181

DR. PUNGKI ADHITAMA P

PER/22-21/112015

RS.TRAUMA CENTRE 18/01/2016 31/12/2016

22 7-1446062441 PUSKESMAS PURWODADI I JL. GAJAH MADA NO. 1, KEC. PURWODADI 581110292421541 DR. RINI ARYANTI

PER/22-22/112015

RS.TRAUMA CENTRE 18/01/2016 31/12/2016

23 7-1446286013 PUSKESMAS PURWODADI II DS. NAMBUHAN, KEC PURWODADI 5811102927701414

DR. RINJANI SURYANINGSIH, MA

PER/22-23/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

24 7-1446397684 PUSKESMAS TANGGUNGHARJO

DS. TANGGUNGHARJO NO. 12A, KEC. TANGGUNGHARJO

58166 DR. KUSAINI PER/22-24/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


79 / 15116-05-201607:59:01



IKS


25 7-1446533475 PUSKESMAS TAWANGHARJO

JL. RAYA PURWODADI BLORA POJOK, KEC. TAWANGHARJO 58191 DRG. RENDRA M PER/22-

25/112015RS.TRAUMA CENTRE 18/01/2016 31/12/2016

26 7-1446647286 PUSKESMAS TEGOWANU JL. GATOT SUBROTO NO. 128, KEC. TEGOWANU 58165 029251351

50 DR. EKO TAKARIYANTO PER/22-26/112015

RS.TRAUMA CENTRE 18/01/2016 31/12/2016

27 7-1446759157 PUSKESMAS TOROH I JL. RAYA SOLO 171 DS. DEPOK, KEC. TOROH 58171 0292552192

AGUS SETIJORINI, SKM PER/22-27/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

28 7-1446805408 PUSKESMAS TOROH II DS. TUNGGAK, KEC.TOROH 58171 DR. ENDAH YULI RATNAWATI

PER/22-28/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

29 7-1446854619 PUSKESMAS WIROSARI I JL. KUSUMA BANGSA, KEC. WIROSARI 58192 0292761029 DJAKA WIDADA B, SKM 445/1722/2014 RS.TRAUMA

CENTRE 18/01/2016 31/12/2016

30 7-1446890010 PUSKESMAS WIROSARI IIJL TAMBAK NO. 1 DS. KARANG ASEM, KEC. WIROSARI 58192 SUTRISNO, SKM

PER/22-30/112015

RS.TRAUMA CENTRE 18/01/2016 31/12/2016

31 1400000000218 RS BHAKTI WIRA TAMTAMA JL DR SOETOMO NO 17 3555944 PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

32 1500000000212 RS ISLAM KENDAL JL AR RAHMAH NO 17 WELERI KENDAL 641870 DRG EDI SUMARWANTO MM MH KES


01/01/2016 31/12/2016

33 1400000000217 RS PELITA ANUGERAHJL RAYA BANDUNGREJO KM 11.5 MRANGGEN 6725555 LIDIA MEGAWATI PER/23/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

34 1500000000210 RS PERMATA BUNDA JL HAYAM WURUK NO 24 PURWODADI 422838 DR H UTOMO DS SPOG PER/31/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

35 1400000000219 RS PERMATA MEDIKA JL MOCH ICHSAN NO 93-97 NGALIYAN 7625005 PER/24/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

36 1500000000211 RSUD DR R SOEDJATI SOEMODIARDJO

JL DI PANJAITAN 36 PURWODADI 421004 DR BAMBANG PUJIYANTO M.KES


01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


80 / 15116-05-201607:59:01



IKS


37 1400000000216 RSUD KOTA SEMARANG JL FATMAWATI NO 1 SEMARANG 6711500 PER/29/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

38 1400000000214 RSUD TUGUREJO JL. RAYA TUGUREJO KM 9 TAMBAK AJI NGALIYAN 7605297 PER/27/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

KANTOR CABANG : L01- KANTOR CABANG SURAKARTA


IKS


1 1500000000142 KLINIK GRIYA HUSADA 1JL. MEKARSARI RT 03 RW 01 POPONGAN KARANGANYAR 6499639

DR HADIASRI WIDIYASARI PER/14/012016

RS.TRAUMA CENTRE 11/01/2016 31/12/2016

2 1500000000143 KLINIK GRIYA HUSADA 2 SURUH KALONG PANDEYAN TASIKMADU RT 1/ RW 7 KARANGANYAR

9726555 DR ITA KUSUMAWATI PER/16/012016 RS.TRAUMA CENTRE

15/03/2016 31/12/2016

3 1500000000144 KLINIK GRIYA HUSADA 4 JL SOLO PURWODADI KM 6 GONDANGREJO KARANGANYAR

29726555 CV GRIYA DAYA MANDIRI


15/03/2016 31/12/2016

4 1500000001791KLINIK NAYAKA HUSADA 07KARANGANYAR

JL RAYA SOLO SRAGEN KM 10 DAWUNG RT02/01 DESA KEMIRI KEBAKKRAMAT 57171


RS.TRAUMA CENTRE 29/01/2016 31/12/2016

5 1500000001215KLINIK NGESTI HUSADA JATI JL SUMPAH PEMUDA NO. G KADIPIRO DR DEVI FIKASARI PER/27/012016

RS.TRAUMA CENTRE 11/01/2016 31/12/2016

6 1400000000516 KLINIK NGUDI SEHATJL. TENTARA PELAJAR NO. 31 SANGGRAHAN GROGOL SUKOHARJO

2974269 SUHADI PER/18/012016RS.TRAUMA CENTRE

11/01/2016 31/12/2016

7 1500000000106 KLINIK NGUDI SEHAT PARANGJORO

SINGKIL RT 03 RW 08 PARANGJORO GROGOL SUKOHARJO

2974269 KLINIK NGUDI SEHAT PARANGJORO


11/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


81 / 15116-05-201607:59:01



IKS


8 1500000000417 KLINIK NURIFA JL SLAMET RIYADI KARTASURA SUKOHARJO ( KIOS PASAR BUMI REJO ) 2601843 DR UMI ARIFAH PER/22/012016 RS.TRAUMA

CENTRE 29/01/2016 31/12/2016

9 7-2885229574 KLINIK PRATAMA IIS MEDIKA

JL SLAMET RIYADI 156 KARTASURA SUKOHARJO 57161 081287929

00CV CHAFAZKA INSAN MULIA PER/43/042016 RS.TRAUMA

CENTRE 13/04/2016 31/12/2018

10 7-2883966473 KLINIK PRATAMA SARI SEHAT

JATI RT 03/02 JATEN KARANGANYAR 57731 91021574 DR SRI HARTINI [PER/41/042016 RS.TRAUMA CENTRE

13/04/2016 31/12/2018

11 7-3073245233 KLINIK TEDUH JL. SUWARNO HONGGOPATI JLOGO GEDANGAN GROGOL SUKOHARJO

57552 666599812556

YAYASAN PANTI KOSALA


02/05/2016 31/12/2018

12 1100000000030 PUSKESMAS KEBAKKRAMAT JL RAYA SOLO- SRAGEN KM 12 825812 PER/01/012016 RS.TRAUMA

CENTRE 15/03/2016 31/12/2016

13 1400000000474 RS DR OEN SOLO BARU PERUMAHAN SOLO BARU GROGOL 620220 RS DR OEN SOLO BARU PER/07/012016RS.TRAUMA CENTRE 11/01/2016 31/12/2016

14 1100000000033 RS DR OEN SURAKARTA JL. BRIGJEND KATAMSO 55 643139 YYS PANTI KOSALA PER/12/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

15 1500000001866 RS HERMINA SOLO JL KOL SUTARTO NO. 16 RT 01/02 JEBRES SURAKARTA

57116 638989 PT MEDIKA LOKA SOLO PER/30/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

16 1100000000034 RS KASIH IBU SURAKARTA JL SLAMET RIYADI 404 714422 YYS KASIH IBU PER/08/012016RS.TRAUMA CENTRE 11/01/2016 31/12/2016

17 1500000001873RS KHUSUS BEDAH KARIMAUTAMA SURAKARTA

JL. AMARTA RAYA 8-10 TERMINAL BARU NGABEYAN KARTASURA 783399

PT. KARIMA UTAMA SEJAHTERA PER/32/012016

RS.TRAUMA CENTRE 11/01/2016 31/12/2016

18 1100000000032 RS KUSTATI JL KAPT MULYADI 249 643013 PER/09/012016RS.TRAUMA CENTRE

11/01/2016 31/12/2016

19 1500000001009 RS LANUD ADI SOEMARMO JL TENTARA PELAJAR MALANGJIWAN COLOMADU

780240 TNI AU SURAKARTA PER/26/012016 RS.TRAUMA CENTRE

15/03/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


82 / 15116-05-201607:59:01



IKS


20 7-2461866504 RS MEDIKA MULYA WONOGIRI

JL WONOGIRI - NGADIROJO KM 5 WONOGIRI 57652 YAYASAN RS MEDIKA

MULYA PER/37/032016 RS.TRAUMA CENTRE 15/03/2016 31/12/2016

21 7-2875438383 RS MULIA HATI WONOGIRI JL RM SAID BRUMBUNG KALIANCAR SELOGIRI 57652 PT MULIA SURGICA

WONOGIRI PER/40/032016 RS.TRAUMA CENTRE 13/04/2016 31/12/2016

22 1400000000536 RS NIRMALA SURI SUKOHARJO

JL SOLO SUKOHARJO KM 9 RS NIRMALA SURI SUKOHARJO


15/01/2016 31/12/2016

23 1100000000035 RS ORTHOPEDI PROF DR SOEHARSO

JL. JEND A YANI PABELAN 714458 PER/02/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

24 1100000000031 RS PANTI WALUYO JL A YANI 1-2 712077 PER/15/012016 RS.TRAUMA CENTRE 11/01/2016 31/12/2016

25 1500000000294RS PKU MUHAMADIYAH SELOGIRI

JL LAMA NAMBANGAN SELOGIRI WONOGIRI 5327504

YYS PKU MUHAMADIYAH PER/21/012016

RS.TRAUMA CENTRE 11/01/2016 31/12/2016

26 1400000000537 RS PKU MUHAMADIYAH SURAKARTA

JL RONGGOWARSITO NO 130 SURAKARTA 714578 RS PKU MUHAMADIYAH SURAKARTA


11/01/2016 31/12/2016

27 1500000001946 RS PKU MUHAMMADIYAH KARANGANYAR

JL PAPAHAN DESA PAPAHAN KECAMATAN TASIKMADU

57171 492685 YAYASAN MUHAMADIYAH


11/01/2016 31/12/2016

28 1500000001628RS PKU MUHAMMADIYAH SRAGEN

JL RAYA SOLO SRAGEN KM 8 MASARAN SRAGEN

YAYASAN MUHAMADIYAH PER/28/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

29 08237RS PKU MUHAMMADIYAH SURAKARTA JL RONGGOWARSITO SURAKARTA 714578

RS PKU MUHAMADIYAH SURAKARTA PER/20/012016

RS.TRAUMA CENTRE 29/01/2016 31/12/2016

30 1500000001531 RSI AMAL SEHAT SRAGEN JL VETERAN NO 35 SRAGENYAYASAN AMAL SEHAT SRAGEN


15/01/2016 31/12/2016

31 7-1689398627 RSO PROF DR R SOEHARSO SURAKARTA

JL A AYANI KARTASURA 50771 71445832 KEMENKES PER/02/012016 RS.TRAUMA CENTRE

29/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


83 / 15116-05-201607:59:01



IKS


32 7-2888512933 RSU INDO SEHAT JL. RAYA SOLO SRAGEN KM 11 KEBAKKRAMAT 57762 YAYASAN INDO SEHAT PER/42/042016 RS.TRAUMA

CENTRE 13/04/2016 31/12/2018

33 1500000000121 RSU JATI HUSADA KARANGANYAR

JL RAYA SOLO TAWANGMANGU KM 10,3 JATI JATEN KARANGANYAR

PT TENTERAM MAKMUR BERSAMA PER/11/012016 RS.TRAUMA

CENTRE 11/01/2016 31/12/2016

34 1500000000687 RSU MARDI LESTARI JL ROKAN NO 8 SRAGEN YYS SANTA KATARINA L PER/27/042015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

35 1500000000687 RSU MARDI LESTARI JL ROKAN NO 8 SRAGEN YYS SANTA KATARINA L PER/24/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

36 1100000000036 RSUD DR MOEWARDI SURAKARTA JL KOL SUTARTO 132 634634 PER/03/012016 RS.TRAUMA

CENTRE 11/01/2016 31/12/2016

37 7-3265778097RSUD DR SOEDIRAN MANGUN SUMARSO KABUPATEN WONOGIRI

JL A YANI NO 40 WONOGIRI 57611 PEMKAB WONOGIRI PER/34/012016RS.TRAUMA CENTRE 10/05/2016 31/12/2016

38 1500000000120 RSUD DR SOEHADI PRIJONEGORO SRAGEN

JL RAYA SUKOWATI 534 SRAGEN PER/13/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

39 1400000000424 RSUD KABUPATEN KARANGANYAR

JL. LAKSDA YOS SUDARSO 495673 RSUD KABUPATEN KARANGANYAR


11/01/2016 31/12/2016

40 1400000000425RSUD KABUPATEN SUKOHARJO JL DR MOEWARDI 71 SUKOHARJO 593118

RSUD KABUPATEN SUKOHARJO PER/05/012016

RS.TRAUMA CENTRE 11/01/2016 31/12/2016

41 1400000000423 RSUD KOTA SURAKARTAJL. LETTU SUMARTO NOMOR : 1 KADIPIRO BANJARSARI 715300 RSUD KOTA SURAKARTA PER/06/012016

RS.TRAUMA CENTRE 29/01/2016 31/12/2016

42 7-2461234733RUMAH SAKIT BRAYAT MINULYA

JL SETIA BUDI 106 5713971664624632

YAYASAN RS BRAYAT MINULYA


15/03/2016 31/12/2016

43 7-3070677308 RUMAH SAKIT JIWA DAERAH SURAKARTA

JL KH DEWANTORO NO. 80 JEBRES SURAKARTA

57121 PEMERINTAH PROPINSI JATENG


02/05/2016 31/12/2018


Periode : 01/01/2016 s/d 31/12/2016


84 / 15116-05-201607:59:01



IKS


44 7-2610514586 RUMAH SAKIT MARGA HUSADA JL LETJEND S PARMAN WONOGIRI 57652 32194455 RS MARGA HUSADA

WONOGIRI PER/39/032016 RS.TRAUMA CENTRE 28/03/2016 31/12/2016

45 7-2519970682 RUMAH SAKIT SARILA HUSADA JL VETERAN NO. 41-43 SRAGEN 57211 89119400 PT SARILA HUSADA PER/23/012016 RS.TRAUMA

CENTRE 15/03/2016 31/12/2016

46 7-2510145183 RUMAH SAKIT UMUM ISLAM YAKSSI GEMOLONG

JL SOLO PURWODADI KM 20 57274 YAYASAN YAKSSI GEMOLONG


15/03/2016 31/12/2016

KANTOR CABANG : L02- KANTOR CABANG CILACAP


IKS


1 7-2832594183 KLINIK HAMADA JL. KENDENG NO. 43 RT 001 RW 004 DESA KURIPAN KEC KESUGIHAN KAB CILACAP

53274 EKO PRIYO ATMOJO, S.KEP.NS


07/04/2016 31/12/2017

2 1500000000550 KLINIK NAYAKA HUSADA JL. KOMPENI NO. 25 PIPA TIMUR 532149 PT NAYAKA ERA HUSADA


19/04/2016 31/12/2017

3 1400000000491RS PKU MUHAMMADIYAH GOMBONG JL. YOS SUDARSO NO. 461 GOMBONG 471780

DR. IBNU NASER A, S. AG,MMR PER/02/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

4 1500000000431 RSU SANTA MARIA CILACAPJL. JEND. A. YANI NO. 38 KEL. SIDAKAYA KEC. CILACAP SELATAN 521725 YAYASAN MEDIATRIX PER/04/042016

RS.TRAUMA CENTRE 19/04/2016 31/12/2017

5 1100000000021 RSUD CILACAP JL GATOT SUBROTO NO. 28 533010DR. NONO RASINO, SP.OG(K)


01/01/2016 31/12/2016

KANTOR CABANG : L03- KANTOR CABANG YOGYAKARTA


Periode : 01/01/2016 s/d 31/12/2016


85 / 15116-05-201607:59:01



IKS


1 1500000000727 BLKPP DI YOGYAKARTA JLN KYAI MOJO NO. 5 YOGYAKARTA 512619 DISNAKERTRANS DIY PER/12/042016 RS.TRAUMA CENTRE 11/04/2016 28/02/2018

2 1500000000400 BP PMI DI YOGYAKARTA JLN RING ROAD BARAT NO. 3, PATHUK, GAMPING, SLEMAN 6499652 PMI PROP DI

YOGYAKARTA PER/03/012016 RS.TRAUMA CENTRE 01/03/2016 28/02/2017

3 1500000000173 BP RB CITRA PARAMEDIKA GRAULAN RT 06 RW 03 GIRIPENI WATES 774876 YAYASAN BINANGUN CITRA PARA MEDIKA


11/04/2016 31/01/2018

4 1500000001289 KLINIK CHANDRA BRATA MEDIKA PLAZA

TAMBAKAN RT 002 RW 019 SINDUHARJO NGAGLIK

882702 ANDRA BRATA MEDIKA PLAZA


01/06/2016 31/05/2018

5 1500000001334 KLINIK HARMONY GENDENG GK IV/969, BACIRO DR. ERNA PER/45/052016 RS.TRAUMA CENTRE 01/06/2016 31/05/2018

6 1500000001238KLINIK HIPERKES DAN KESELAMATAN KERJA

JLN. IREDA NO.38, KEPARAKAN, MERGANGSAN BALAI HIPERKES PER/21/052016

RS.TRAUMA CENTRE 09/05/2016 31/05/2018

7 1500000001284 KLINIK LARAS HATI PRANCAK, GLONDONG, PANGGUNGHARJO, SEWON, BANTUL

RB LARAS HATI PER/46/052016 RS.TRAUMA CENTRE

01/06/2016 31/05/2018

8 1500000001285 KLINIK LARAS HATI KULON PROGO

WONOLOPO RT 33 RW 15, GULUREJO, LENDAH

55663 YAYASAN BHAKTI SOSIAL


01/06/2016 31/05/2018

9 1500000001160 KLINIK PATALANJLN. PARANG TRITIS KM 15, PATALAN, JETIS DR GLORY PER/37/052016

RS.TRAUMA CENTRE 29/05/2016 30/04/2018

10 1500000000598KLINIK PRATAMA ANUGERAH

JLN RINDANG NO. 145, JADAN, TAMANTIRTO, KASIHAN 789670 DR. AR ROYAN PER/16/042016

RS.TRAUMA CENTRE 11/04/2016 31/03/2018

11 1500000001237KLINIK PRATAMA KARTIKA HUSADA

TEGALREJO NGLEGIS RT 05. SITIMULYO, BANTUL


01/06/2016 31/05/2018

12 1500000000048 KLINIK PRATAMA MITRA SEHAT

JL IMOGIRI TIMUR KM 6 DLADAN BARU NGLEBENG TAMANAN BANGUNTAPAN

9103190 CV MITRA SEHAT PER/50/122015 RS.TRAUMA CENTRE

18/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


86 / 15116-05-201607:59:01



IKS


13 1500000000062 KLINIK PRATAMA SWA JL SALAK/TURI KM 4 KADISOBO II RT 02 RW03 TRIMULYO 7485660 YAYASAN SWA

YOGYAKARTA PER/51/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

14 1500000000063 KLINIK PRATAMA WIDURI JL MAGELANG KM 12 WIDORO TRIHARJO SLEMAN 867363 CV WIDURI PER/53/122015 RS.TRAUMA

CENTRE 18/01/2016 31/12/2016

15 1500000001669 KLINIK UTAMA BEDAH ADELIA

DONOLOYO IA KROBOKAN TAMANAN BANGUNTAPAN

4396680 TRIYONO PER/43/052016 RS.TRAUMA CENTRE

01/06/2016 31/05/2018

16 1500000001037 PUSKESMAS BAMBANGLIPURO

DAWETAN, SIDOMULYO, BAMBANGLIPURO DINKES BANTUL PER/23/082016 RS.TRAUMA CENTRE

28/05/2016 30/04/2018

17 1500000000399 PUSKESMAS BANGUNTAPAN II

KROBOKAN DESA TAMANAN, BANGUNTAPAN , BANTUL DINKES KAB BANTUL PER/10/042015 RS.TRAUMA

CENTRE 11/04/2016 28/02/2018

18 1500000001042 PUSKESMAS DLINGO I KORIPAN, DLINGO, BANTUL DINKES BANTUL PER/24/052016RS.TRAUMA CENTRE 28/05/2016 30/04/2018

19 1500000001038 PUSKESMAS IMOGIRI I NGANCAR, KARANGTALUN, IMOGIRI, BANTUL

DINKES BANTUL PER/25/052016 RS.TRAUMA CENTRE

28/05/2016 30/04/2018

20 1500000001067 PUSKESMAS JETIS I TELAN TRIMULY, JETIS BANTUL DINKES BANTUL PER/26/052016 RS.TRAUMA CENTRE

28/05/2016 30/04/2018

21 1500000001064 PUSKESMAS KASIHAN I NGENTAK, BANGUNJIWO, KASIHAAN DINKES BANTUL PER/27/052016RS.TRAUMA CENTRE 28/05/2016 30/04/2018

22 1500000000802 PUSKESMAS KRETEKJL PARANGTRITIS KM 21, SRUWUH, DONOTIRTO, KRETEK DINKES KAB BANTUL PER/28/052016

RS.TRAUMA CENTRE 09/05/2016 30/04/2018

23 1500000001049 PUSKESMAS PAJANGAN BEJI, SENDANGSARI, PAJANGAN, BANTUL DINKES BANTUL PER/29/052016RS.TRAUMA CENTRE

28/05/2016 30/04/2018

24 1500000001063 PUSKESMAS PANDAK I GESIKAN, WIJIREJO, PANDAK DINKES BANTUL PER/30/052016 RS.TRAUMA CENTRE

28/05/2016 30/04/2018


Periode : 01/01/2016 s/d 31/12/2016


87 / 15116-05-201607:59:01



IKS


25 1500000001041 PUSKESMAS PIYUNGAN PAYAK, SRIMULYO, PIYUNGAN DINKES BANTUL PER/22/072016 RS.TRAUMA CENTRE 28/05/2016 30/04/2018

26 1500000001047 PUSKESMAS PLERET WONOKROMO, PLERET, BANTUL DINKES BANTUL PER/31/052016 RS.TRAUMA CENTRE 28/05/2016 30/04/2018

27 1500000001039 PUSKESMAS PUNDONG PIRING, SRIHARDONO, PUNDONG, BANTUL DINKES BANTUL PER/32/052016 RS.TRAUMA CENTRE

28/05/2016 30/04/2018

28 1500000001048 PUSKESMAS SANDEN PUCANGANOM, MURTIGADING, SANDEN DINKES BANTUL PER/33/052016 RS.TRAUMA CENTRE

28/05/2016 30/04/2018

29 1500000001066 PUSKESMAS SEDAYU I KEMUSUK, ARGOMULYO, SEDAYU DINKES BANTUL PER/34/052016 RS.TRAUMA CENTRE 28/05/2016 30/04/2018

30 1500000000803 PUSKESMAS SEWON IJLN. PARANGTRITIS KM 7, BANGI, TIMBULHARJO, SEWON DINKES BANTUL PER/35/052016

RS.TRAUMA CENTRE 09/05/2016 30/04/2018

31 1500000000804 PUSKESMAS SRANDAKAN JL. RAYA SRANDAKAN, TRIMURTI, SRANDAKAN

DINKES BANTUL PER/36/052016 RS.TRAUMA CENTRE

09/05/2016 30/04/2018

32 1400000000143 RS CONDONG CATUR JL MANGGIS NO 6 GEMPOL CONDONG CATUR

887494 DR HERTI ELIZA SILALAHI


01/06/2016 31/05/2018

33 1500000000447 RS ISLAM HIDAYATULLAHJLN. VETERAN NO. 184, PANDEYAN, UMBULHARJO 389184 PT. RSI HIDAYATULLAH PER/15/042016

RS.TRAUMA CENTRE 11/04/2016 31/03/2018

34 1400000000142 RS PANTI NUGROHO JL KALIURANG KM 17 895186 YAYASAN PANTI RAPIH PER/14/042016RS.TRAUMA CENTRE 11/04/2016 31/03/2018

35 1500000000449 RS PANTI RINIJLN SOLO KM 13,2 KRAJAN, KALASAN, SLEMAN

496022 YAYASAN PANTI RAPIH PER/07/042016RS.TRAUMA CENTRE

06/04/2016 31/03/2018

36 1400000000005 RS PKU MUHAMMADIYAH BANTUL

JL. JEND SUDIRMAN NO.124 368238 YAYASAN MUHAMMADIYAH


18/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


88 / 15116-05-201607:59:01



IKS


37 1400000000312 RS PKU MUHAMMADIYAH YOGYAKARTA JL KHA DAHLAN 20 512653 YAYASAN

MUHAMMADIYAH PER/18/052016 RS.TRAUMA CENTRE 09/05/2016 30/04/2018

38 1400000000136 RS QUEEN LATIFA JL RING ROAD BARAT MLANGI NOGOTIRTOGAMPING 581402 PER/48/122015 RS.TRAUMA

CENTRE 18/01/2016 31/12/2016

39 1400000000139 RS RAJAWALI CITRA JL.PLERET KM 2,5 BANJARDADAP POTORONO BANGUNTAPAN BANTUL

7482003 DR H SUNU PRASMONO PER/19/042016 RS.TRAUMA CENTRE

12/05/2016 30/04/2018

40 1500000001287RSKIA PKU MUHAMMADIYAH KOTAGEDE

JLN KEMASAN NO.43, PURBAYAN, KOTAGEDE

MUHAMMADIYAH PER/39/052016 RS.TRAUMA CENTRE

01/06/2016 31/05/2018

41 1500000001033 RSU AT-TUROST AL-ISLAMY JLN. KLACI I, MARGOLUWIH, SEYEGAN YAYASAN MAJELIS AT-TUROST AL-ISLAMY PER/40/052016 RS.TRAUMA

CENTRE 09/05/2016 30/04/2018

42 1400000000478RSU BHAYANGKARA POLDADI YOGYAKARTA

JL JOGYA-SOLO KM 14 GLONDONG TIRTOMARTANI KALASAN 498278 POLDA DI YOGYAKARTA PER/44/122015

RS.TRAUMA CENTRE 18/01/2016 30/11/2016

43 1500000000812 RSU GRIYA MAHARDIKA YOGYAKARTA

JLN. PARANGTRITIS KM 4,5 GG. WIJAYAKUSUMA NO. 212, SEWON

445020 PT. RSGM PER/41/052016 RS.TRAUMA CENTRE

18/05/2016 30/04/2018

44 1400000000138 RSU KAB SLEMAN JL BHAYANGKARA 48 MORANGAN SLEMAN

868437 PEMKAB BANTUL PER/13/042016 RS.TRAUMA CENTRE

11/04/2016 31/03/2018

45 1500000000168RSU KHARISMA PARAMEDIKA JL KHUDORI NO. 34 WATES 774633

YAYASAN BINANGUN KHARISMA PARAMEDIKA


46 1500000000169 RSU MITRA SEHAT JL WATES KM. 9 BALECATUR GAMPING 6498555 PT EMPAT MITRA PER/08/042016RS.TRAUMA CENTRE 11/04/2016 31/01/2018

47 1500000000349 RSU PURI HUSADAJLN PALAGAN TENTARA PELAJAR KM 11 NO.67 SARIHARJO, NGAGLIK

867270PT. HUSADA EDUKA HOLISTIKA


01/02/2016 31/01/2017

48 1500000000858 RSU RACHMA HUSADA JLN PARANG TRITIS KM 16, PATALAN, JETIS, BANTUL

YAYASAN BINA MITRA HUSADA


09/05/2016 30/04/2018


Periode : 01/01/2016 s/d 31/12/2016


89 / 15116-05-201607:59:01



IKS


49 1500000000327 RSUD KOTA YOGYAKARTA JL WIROSABAN NO.1 YOGYAKARTA 371195 PEMKOT YOGYAKARTA PER/01/012016 RS.TRAUMA CENTRE 01/02/2016 31/01/2017

50 1400000000475 RSUD WATES JL TENTARA PELAJAR KM 1 NO 5 773169 PEMDA KULON PROGO PER/43/122015 RS.TRAUMA CENTRE 18/01/2016 31/10/2016

51 1500000000586 RSUP DR SARDJITO JLN KESEHATAN NO. 1, SEKIP, SINDUADI 587333 KEMENKES PER/06/042016 RS.TRAUMA CENTRE

04/04/2016 31/03/2017

52 1400000000479RUMAH SAKIT AKADEMIK UNIVERSITAS GADJAH MADA

JL KABUPATEN KRONGGAHAN TRIHANGGO GAMPING

4530404 UNIVERSITAS GADJAH MADA


18/01/2016 30/11/2016

53 1400000000315 RUMAH SAKIT ISLAM YOGYAKARTA PDHI JL SOLO KM 12,5 KALASAN SLEMAN 498000 PROF.DR.DR.H

LAMSUDIN PER/47/122015 RS.TRAUMA CENTRE 11/04/2016 31/12/2016

54 1400000000480RUMAH SAKIT LUDIRA HUSADA TAMA JL WIRATAMA NO. 4 TEGALREJO 620333

DR BONDAN AGUS SURYANTO PER/46/122015

RS.TRAUMA CENTRE 18/01/2016 30/11/2016

55 1400000000695 RUMAH SAKIT NUR ROHMAH

JL WONOSARI-YOGYA KM 7 BANDUNG PLAYEN

394574 PT.RAHMA BAKTI HUSADA


18/01/2016 31/12/2016

56 1400000000696 RUMAH SAKIT PANTI RAHAYU

JALAN WONOSARI-PONJONG KM 7 KELOR KARANGMOJO

392718 YAYASAN PANTI RAPIH PER/52/122015 RS.TRAUMA CENTRE

18/01/2016 31/12/2016

57 1400000000134 RUMAH SAKIT PANTI RAPIH JALAN CIK DI TIRO NO 30 514014 YAYASAN PANTI RAPIH PER/20/052016RS.TRAUMA CENTRE 09/06/2016 31/05/2018

KANTOR CABANG : L04- KANTOR CABANG PEKALONGAN


Periode : 01/01/2016 s/d 31/12/2016


90 / 15116-05-201607:59:01



IKS


1 1400000000411 RS QOLBU INSAN MULIA (QIM) JL URIP SUMOHARJO - SAMBONG 51211 4495222 PT QOLBU INSAN MULIA PER / 24 /112015 RS.TRAUMA

CENTRE 25/02/2016 31/10/2016

2 1400000000411 RS QOLBU INSAN MULIA (QIM) JL URIP SUMOHARJO - SAMBONG 51211 4495222 PT QOLBU INSAN MULIA PER / 24 /112015 RS.TRAUMA

CENTRE 24/02/2016 31/10/2016

3 1500000000214 RSI PKU MUHAMMADIYAH PEKAJANGAN

JL RAYA AMBOKEMBANG NO 42-43 KEDUNGWUNI

51173 785133 YAYASAN MUHAMMADIYAH

PER / 002 / 022016

RS.TRAUMA CENTRE

02/03/2016 31/12/2017

KANTOR CABANG : L05- KANTOR CABANG KUDUS


IKS


1 1500000000942 KLINIK PRATAMA ANUGERAH HEXA

JL JEPARA KM 3 TERSONO GARUNG LOR KALIWUNGU

DR ANWAR RIYANTO PER/07/042016 RS.TRAUMA CENTRE

13/04/2016 31/12/2017

2 1500000000942 KLINIK PRATAMA ANUGERAH HEXA

JL JEPARA KM 3 TERSONO GARUNG LOR KALIWUNGU

DR ANWAR RIYANTO PER/11/042016 RS.TRAUMA CENTRE

14/04/2016 31/12/2017

3 7-1073301393KLINIK PRATAMA SEJAHTERA JL RA KARTINI NO 15 PATI 59111 DR JOKO MARDIYANTO PER.030/X/2015

RS.TRAUMA CENTRE 07/01/2016 30/09/2016

4 1500000000641POLIKLINIK YASMIN MEDIKA

JL SOEKARNO HATTA KM 4.8 RT 7/8 TAHUNAN 727047406 DINY NOOR KHAYATI PER/04/042016

RS.TRAUMA CENTRE 13/04/2016 31/12/2017

5 1500000000641POLIKLINIK YASMIN MEDIKA

JL SOEKARNO HATTA KM 4.8 RT 7/8 TAHUNAN

727047406 DINY NOOR KHAYATI PER/10/042016RS.TRAUMA CENTRE

14/04/2016 31/12/2017

6 1500000000661 RS PERMATA JL REKSODIPURO NO 57 531624 PER/05/042016 RS.TRAUMA CENTRE

13/04/2016 31/12/2017


Periode : 01/01/2016 s/d 31/12/2016


91 / 15116-05-201607:59:01



IKS


7 1500000000661 RS PERMATA JL REKSODIPURO NO 57 531624 PER/08/042016 RS.TRAUMA CENTRE 14/04/2016 31/12/2017

8 1500000000335 RSI ARAFAH REMBANG JL RAYA REMBANG LASEM KM5 TRITUNGGAL 531666 RSI ARAFAH REMBANG PER/07/042016 RS.TRAUMA

CENTRE 14/04/2016 31/12/2017

9 1500000000335 RSI ARAFAH REMBANG JL RAYA REMBANG LASEM KM5 TRITUNGGAL

531666 RSI ARAFAH REMBANG PER/03/042016 RS.TRAUMA CENTRE

13/04/2016 31/12/2017

10 1500000000642 RSI ISLAM PATI JL RAYA PATI TAYU KM 18 DS WATUROYO MARGOYOSO

YKM NU PER/06/042016 RS.TRAUMA CENTRE

14/04/2016 31/12/2017

11 1500000000642 RSI ISLAM PATI JL RAYA PATI TAYU KM 18 DS WATUROYO MARGOYOSO YKM NU PER/06/042016 RS.TRAUMA

CENTRE 13/04/2016 31/12/2017

12 1500000000138RSI SULTAN HADLIRIN JEPARA

JL RAYA JEPARA BANGSRI KM 3 DS KUWASEN 591507

RSI SULTAN HADLIRIN JEPARA PER/003/012016

RS.TRAUMA CENTRE 02/02/2016 31/12/2017

13 05896 RSK MARDI RAHAYU JL AKBP R AGIL KUSUMADYA NO 110 KUDUS

434707YAYASAN KRISTEN KESEJAHTERAAN MARDIRAHAYU

1482/DIR/PKS/I/2016

RS.TRAUMA CENTRE

19/01/2016 01/12/2016

14 05896 RSK MARDI RAHAYU JL AKBP R AGIL KUSUMADYA NO 110 KUDUS

434707YAYASAN KRISTEN KESEJAHTERAAN MARDIRAHAYU


20/01/2016 31/12/2016

15 1500000000164RSU DR R SOETIJONO BLORA JL DR SUTOMO NO 42 531118 RSU DR R SOETIJONO PER/004/012016

RS.TRAUMA CENTRE 02/02/2016 31/12/2017

16 7-1061786476RSUD DR LOEKMONO HADI KUDUS JL DR LOEKMONO HADI NO 19 KUDUS 59319

0291444001 PEMERINTAH DAERAH

440/327/23.01.01/2015

RS.TRAUMA CENTRE 07/01/2016 31/12/2016

17 7-1511265053 RSUD KELET JL RAYA KELET KM 33 JEPARA 59454DR WIDYO KUNTO M KESMRS

910/1448.B/X/2015

RS.TRAUMA CENTRE

20/01/2016 31/10/2017

18 1400000000558 RSUD RA KARTINI KABUPATEN JEPARA

JL. WACHID HASYIM NO.100 591175 RSUD JEPARA PER/004/022016 RS.TRAUMA CENTRE

22/02/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


92 / 15116-05-201607:59:01



IKS


19 7-1601479543 RSUD RAA SOEWONDO PATI JL.DR. SUSANTO NO. 114 PATI 59163 DR. SUWORO NURCAHYONO.M.KES PER/009/012016 RS.TRAUMA

CENTRE 26/01/2016 31/12/2016

20 7-1061786478 RUMAH SAKIT KELUARGA SEHAT JL P SUDIRMAN NO 9 MARGOREJO PATI 59163 295386111 SWASTA 8784/KSH/PKS/

XI/2015RS.TRAUMA CENTRE 12/01/2016 01/09/2017

21 1500000000137 RUMAH SAKIT KUMALASIWI KUDUS

JL JEPARA KM 6 DESA MIJEN RT 10 RW 06 KALIWUNGU

4245551 RUMAH SAKIT KUMALASIWI KUDUS


02/02/2016 31/12/2017

22 7-1534312103 RUMAH SAKIT MARDI RAHAYU KUDUS

JL AKBP R AGIL KUSUMADYA KUDUS 59346 DR KHRISNA NUGRAHA W


21/01/2016 31/12/2016

23 7-1534989054 RUMAH SAKIT UMUM DAERAH KELET JL RAYA KELET KM 33 JEPARA 59431 DR WIDYO KUNTO M.KES

MRSPER/0035/112015

RS.TRAUMA CENTRE 21/01/2016 31/12/2016

KANTOR CABANG : L06- KANTOR CABANG MAGELANG


IKS


1 1500000000112RS PKU MUHAMMADIYAH TEMANGGUNG

JALAN RAYA KEDU KM 2 KALISAT CAMPURSARI BULU TEMANGGUNG 596704

PIMPINAN DAERAH MUHAMMADIYAH TEMANGGUNG


2 1400000000467RSU PKU MUHAMMADIYAH PURWOREJO

JL BRIGJEN KATAMSO NO 144A RT 1 RW 5 PANGENREJO PURWOREJO 325260

YAYASAN RSU PKU MUHAMMADIYAH PER/18/112014

RS.TRAUMA CENTRE 13/04/2016 31/12/2015

3 1400000000467RSU PKU MUHAMMADIYAH PURWOREJO

JL BRIGJEN KATAMSO NO 144A RT 1 RW 5 PANGENREJO PURWOREJO

325260YAYASAN RSU PKU MUHAMMADIYAH


13/04/2016 31/12/2017

4 7-1712506763 RSUD DR TJITROWARDOJO PURWOREJO

JL. JENDERAL SUDIRMAN NO. 60 PURWOREJO

54114 275321118RSUD DR TJITROWARDOJO PURWOREJO


29/01/2016 31/12/2017


Periode : 01/01/2016 s/d 31/12/2016


93 / 15116-05-201607:59:01



IKS


5 1500000000113 RUMAH SAKIT ISLAM WONOSOBO

JL MAYJEN BAMBANG SUGENG KM 03 MENDOLO BUMIRESO 322961

YAYASAN AMAL DAN KESEJAHTERAAN UMAT ISLAM (YAKAUMI)


6 1500000000113 RUMAH SAKIT ISLAM WONOSOBO

JL MAYJEN BAMBANG SUGENG KM 03 MENDOLO BUMIRESO 322961

YAYASAN AMAL DAN KESEJAHTERAAN UMAT ISLAM (YAKAUMI)


KANTOR CABANG : L07- KANTOR CABANG TEGAL


IKS


1 1500000001580 KLINIK AZ-ZAHRA JL RAYA LEBAKSIU RT 02/03 LEBAKSIU LOR DR M KARIM AMRULLAH PER/09/2015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

2 1500000001579 KLINIK KS TUBUN 81 JL KS TUBUN NO 81 RT 01/01 KEL DEBONGTENGAH

0818289836

DR SUHARJO PER/10/2015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

3 7-2131721414 KLINIK MONAS WOUND CARE TEGAL

JL RAYA TALANG RT 11/02 TALANG 52415 DR SUWASPODO PER/16/2016 RS.TRAUMA CENTRE

22/02/2016 31/01/2017

4 7-2131470963KLINIK NAYAKA HUSADA 06BALAMOA JL PASAR BALAMOA RT 01/01 PANGKAH 52415 DAWAM RAHARJO PER/17/012016

RS.TRAUMA CENTRE 22/02/2016 31/12/2016

5 1500000001755 KLINIK SEJAHTERA 1DESA TEMBOK LOR RT 10/02 KEC ADIWERNA 52194 7608142 DR NAJMUL IMAN PER/12/2015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

6 1500000001756 KLINIK SEJAHTERA 2DESA HARJOSARI KIDUL RT 24/06 KEC ADIWERNA

52194 7608142 DR NAJMUL IMAN PER/13/2015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

7 1200000000015 RS BHAKTI ASIH BREBES (TC)

JL P DIPONEGORO PESANTUNAN 125 BREBES

673481 DR KHOSIATUN AZMI PER/05/2015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


94 / 15116-05-201607:59:01



IKS


8 0900000000036 RS DEDY JAYA (TC) JL AHMAD YANI NO 57 672525 DR IRMA YURITA PER/02/2015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

9 1500000000186 RS MITRA SIAGA JL PALA RAYA NO 54 KEC KRAMAT 322550 PER/01/012015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

10 1000000000009 RSI PKU MUHAMMADIYAH KABUPATEN TEGAL(TC)

JALAN RAYA SINGKIL KM 0.5 ADIWERNA 3448180 DR H. ACHMAD SHOCHIBUL BIRRI


03/03/2016 31/12/2016

11 1500000001754 RSU ADELLA JL PROF MOH YAMIN NO 77 KEL KUDAILE KEC SLAWI

52419 491154 DR H M ABDUL DJALIL MKES


01/01/2016 31/12/2016

12 01626 RSU KARDINAH TEGAL JL KS TUBUN NO. 1 TEGAL PER/14/2015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

13 0800000000030 RSU SITI ASIYAH JL PASAR WAGE BUMIAYU 41059007 DR H FAISAL AMRI, SH PER/07/0122016RS.TRAUMA CENTRE 03/03/2016 31/12/2016

14 0900000000035 RSUD DR SOESELO SLAWI (TC)

JL DR SUTOMO NO 63 SLAWI 491991 DR WIDODO JOKO MULYONO, M,KES,MMR


01/01/2016 31/12/2016

15 1500000001236 RSUD SURADADI JL RAYA TEGAL-PEMALANG KM.12 SURADADI

3336263 PEMERINTAH KABUPATEN TEGAL


01/01/2016 31/12/2016

16 0900000000029 RSUI HARAPAN ANDA (TC) JL ABABIL NO 42 353387 HABIYAH. MMR PER/03/2015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

KANTOR CABANG : L08- KANTOR CABANG KLATEN


Periode : 01/01/2016 s/d 31/12/2016


95 / 15116-05-201607:59:01



IKS


1 1400000000435 KLINIK INSAN SEHAT JL. RAYA BOYOLALI SELO KM 5 JELOK CEPOGO

081393306461 PT RESTU BUNDA PER/24/112015 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

2 7-1549815415KLINIK NAYAKA HUSADA 02BOYOLALI DK. BUTUH MOJOSONGO BOYOLALI 57322

0247605621

YAYASAN DANA PENSIUN KARYAWAN BPJS KETENAGAKERJAAN


3 1500000000102 KLINIK PKU MUH JATINOM JL RAYA JATINOM KLATEN KM 1 KLATEN 337334YAYASAN MUHAMMADIYAH CAB JATINOM KLATEN


4 1500000000688 KLINIK PKU MUHAMMADIYAH CAWAS

JL CAWAS PEDAN BELAKANG POLSEK CAWAS KLATEN

897661YAYASAN MUHAMMADIYAH CABANG CAWAS


03/05/2016 31/12/2017

5 1500000000688 KLINIK PKU MUHAMMADIYAH CAWAS

JL CAWAS PEDAN BELAKANG POLSEK CAWAS KLATEN 897661

YAYASAN MUHAMMADIYAH CABANG CAWAS

PER/14/04/2016 RS.TRAUMA CENTRE 02/05/2016 30/04/2017

6 1500000000444KLINIK PKU MUHAMMADIYAH POLAN HARJO

JL COKRO DELANGGU GUDANG ABANG WANGEN POLANHARJO 557002

PIMPINAN CABANG MUHAMMADIYAH POLANHARJO KABUPATEN KLATEN


7 1500000000083 KLINIK PRATAMA RAWAT INAP MILA HUSADA

JL . RAYA PENGGING KM 02 BANYUDONO BOYOLALI

327453 DR. H DIDIK SUPRAPTO PER/05/012016 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

8 1500000000293 KLINIK UPK PMI KLATEN JL. VETERAN NO 80 KLATEN UTARA 8850400 DR TRI ARI SUSANTO PER/009/032016 RS.TRAUMA CENTRE

03/03/2016 31/12/2017

9 1400000000147 RS HIDAYAH BOYOLALI KRAGILAN MOJOSONGO BOYOLALI 324614YAYASAN DUA SEPTEMBER BOYOLALI PER/18/052016

RS.TRAUMA CENTRE 01/06/2016 31/05/2017

10 1400000000147 RS HIDAYAH BOYOLALI KRAGILAN MOJOSONGO BOYOLALI 324614 YAYASAN DUA SEPTEMBER BOYOLALI PER/018/052016 RS.TRAUMA

CENTRE 01/06/2016 31/12/2017

11 1500000000445RS KARANGGEDE SISMA MEDIKA

JL RAYA KARENGGEDE SOLO KM 1 KEBONAN KARANGGEDE BOYOLALI

610600PT SISMADI MEDCORPINDO BOYOLALI


13/04/2016 31/03/2017

12 0800000000001 RSI KLATEN JL YOGYA-SOLO KETANDAN KLATEN PER/01/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


96 / 15116-05-201607:59:01



IKS


13 1500000000292 RSU ASY SYIFA SAMBI BOYOLALI

JL RAYA BANGAK SIMO KM 7 SAMBI BOYOLALI 3294459 YAYASAN KARTIKA

HUSADA SAMBI PER/010/03/2016 RS.TRAUMA CENTRE 03/03/2016 31/12/2017

14 7-1550676406 RSU CAKRA HUSADA KLATEN JL. MERBABU NO 7 57412 PT CAKRA HUSADA PER/08/012016 RS.TRAUMA

CENTRE 25/01/2016 31/12/2016

15 0800000000004 RSU PANDAN ARANG BOYOLALI

JL KANTIL 14 BOYOLALI PER/02/012016 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

16 1100000000010 RSU PKU AISYIYAH BOYOLALI

JL. PASAR SAPI BARU SINGKIL-KARANGGENENG BOYOLALI

322898 PER/13/04/2016 RS.TRAUMA CENTRE

03/05/2016 31/12/2017

17 1100000000010 RSU PKU AISYIYAH BOYOLALI

JL. PASAR SAPI BARU SINGKIL-KARANGGENENG BOYOLALI 322898 PER/13/04216 RS.TRAUMA

CENTRE 02/05/2016 30/04/2017

18 0800000000002RSU SOERADJI TIRTONEGORO JL SURADJI TIRTONEGORO PER/04/012016

RS.TRAUMA CENTRE 04/01/2016 31/12/2016

19 0800000000005 RSUD BANYUDONO JL RAYA SOLO-SEMARANG 085647136655

PEMDA PER/03/012016 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

KANTOR CABANG : L09- KANTOR CABANG PURWOKERTO


IKS


1 1400000000187 RSI PURWOKERTO JL H MASYHURI NO 39 PURWOKERTO 630019 YARSI PURWOKERTO PER/001/012016RS.TRAUMA CENTRE

21/01/2016 31/12/2017

2 1500000000680 RSKB JATIWINANGUN JL JATIWINANGUN NO 54 PURWOKERTO 638169 PT SANATIO PER/006/012016 RS.TRAUMA CENTRE

27/04/2016 31/12/2017


Periode : 01/01/2016 s/d 31/12/2016


97 / 15116-05-201607:59:01



IKS


3 1400000000238 RSUD AJIBARANG JL RAYA PANCASAN 6570004 PER/002/012016 RS.TRAUMA CENTRE 13/05/2016 31/12/2017

4 1500000000118 RSUD PROF DR MARGONO SOEKARJO JL DR GUMBREG NO 1 PURWOKERTO 632708 PER/005/022016 RS.TRAUMA

CENTRE 25/04/2016 31/12/2018

5 7-3297996775 RUMAH SAKIT SIAGA MEDIKA

JL PRAMUKA 55 BANYUMAS 53192 YAYASAN SIAGA SEJAHTERA


13/05/2016 31/12/2017

KANTOR CABANG : L10- KANTOR CABANG UNGARAN


IKS


1 1500000000867 GRIYA PELATIHAN APAC (GRIPAC)

JL SOEKARNO HATTA KM.32 DESA HARJOSARI BAWEN

522914 PT APAC INTI CORPORA PER/09/012016 RS.TRAUMA CENTRE

25/02/2016 31/12/2016

2 1400000000657 KLINIK APAC INTI CORPORA JL SOEKARNO HATTA KM 32 HARJOSARI BAWEN

522888 H AGUNG WAHONO SH.MHUM


13/01/2016 31/12/2016

3 1500000001574KLINIK PRATAMA "MANUNGGAL" JL ARGO BUSONO NO.1 322480 KOPERASI PT DAMATEX PER/08/012016

RS.TRAUMA CENTRE 25/02/2016 31/12/2016

4 1400000000656KLINIK UMUM 24 JAM UMI HABIBAH

JL SYECH BASARUDIN KEL.NGEMPON, BERGAS 526225 SITI MUSRIYATUN PER/05/012016

RS.TRAUMA CENTRE 13/01/2016 31/12/2016

5 7-2008582105 PUSKESMAS AMBARAWAJL JENDRAL SUDIRMAN NO 76 KEC AMBARAWA KAB SEMARANG

50611DINAS KESEHATAN KABUPATEN SEMARANG


15/02/2016 31/12/2016

6 7-2008950288 PUSKESMAS BANCAK JL JENDRAL SUDIRMAN NO 1 KEC BANCAK KAB SEMARANG

50125 DINAS KESEHATAN KAB SEMARANG


15/02/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


98 / 15116-05-201607:59:01



IKS


7 7-2008215164 PUSKESMAS BANYUBIRU JL WIJAYA KUSUMA 47 KEC BANYUBIRU KAB SEMARANG 50664 DINAS KESEHATAN KAB

SEMARANG PER/07/012016 RS.TRAUMA CENTRE 15/02/2016 31/12/2016

8 1500000000341 PUSKESMAS BAWEN JL PALAGAN NO. 60 KEC. BAWEN 591539 DINAS KESEHATAN KAB.SEMARANG PER/07/012016 RS.TRAUMA

CENTRE 12/02/2016 31/12/2016

9 1500000000340 PUSKESMAS BERGAS JL SOEKARNO HATTA KEC.BERGAS 6525695 DINAS KESEHATAN KAB SEMARANG


12/02/2016 31/12/2016

10 7-2008826037 PUSKESMAS BRINGIN JL DIPONOGORO NO 141 BRINGIN KEC BRINGIN KAB SEMARANG



15/02/2016 31/12/2016

11 7-1990357685 PUSKESMAS DADAPAYAM JL RAYA DADAPAYAM NO.79, KEC SURUH 50186 02987108802

DINAS KESEHATAN KAB.SEMARANG PER/07/012016 RS.TRAUMA

CENTRE 12/02/2016 31/12/2016

12 1500000000338 PUSKESMAS DUREN JL KENDALISODO NO.19 KEC.BANDUNGAN 711355DINAS KESEHATAN KAB SEMARANG PER/07/012016

RS.TRAUMA CENTRE 12/02/2016 31/12/2016

13 7-2006436553 PUSKESMAS GEDANGAN JL RAYA SALATIGA MUNCUL KM 3 KEC TUNTANG KAB SEMARANG

50131 0246921238

DINKES KAB SEMARANG PER/07/012016 RS.TRAUMA CENTRE

15/02/2016 31/12/2016

14 1500000000325 PUSKESMAS GETASAN JL RAYA SALATIGA KOPENG KM 10 KEC.GETASAN

2838099 DINAS KESEHATAN KAB.SEMARANG


12/02/2016 31/12/2016

15 1500000000337 PUSKESMAS JAMBUJL. RAYA SEMARANG MAGELANG KM 4 KEC.JAMBU 593532

DINAS KESEHATAN KAB.SEMARANG PER/07/012016

RS.TRAUMA CENTRE 12/02/2016 31/12/2016

16 7-1989943593 PUSKESMAS JETAK DS.JETAK , KEC.GETASAN 507740298314664 DINKES KAB SEMARANG PER/07/012016

RS.TRAUMA CENTRE 12/02/2016 31/12/2016

17 7-2008732846 PUSKESMAS JIMBARANJL TEGAL PANAS JIMBARAN KEC BAWEN KAB SEMARANG

50661DINAS KESEHATAN KAB SEMARANG


15/02/2016 31/12/2016

18 7-1990221924 PUSKESMAS KALIWUNGU JL AMPEL SIMO 186, KEC.KALIWUNGU 50221 02763331213

DINKES KAB SEMARANG PER/07/012016 RS.TRAUMA CENTRE

12/02/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


99 / 15116-05-201607:59:01



IKS


19 7-2009520872 PUSKESMAS KALONGAN JL ARJUNA NO 2 KE UNGARAN TIMUR KAB SEMARANG 50514 DINAS KESEHATAN KAB


20 7-2009063660 PUSKESMAS LEREP JL YUDISTIRA RAYA KM 3 KEC UNGARAN TIMUR KAB SEMARANG 50514 DINAS KESEHATAN KAB


21 7-2009405851 PUSKESMAS LEYANGAN JL PUSKESMAS NO 1 KEC UNGARAN BARATKAB SEMARANG



15/02/2016 31/12/2016

22 7-1990444836 PUSKESMAS PABELAN JL PEMUDA NO.98 PABELAN, KEC,PABELAN 50771 0298321124

DINAS KESEHATAN KAB.SEMARANG


12/02/2016 31/12/2016

23 1500000000339 PUSKESMAS PRINGAPUS JL.HONGOWICONO NO.5 KEC. PRINGAPUS 25721150 DNIAS KESEHATAN KAB.SEMARANG PER/07/012016 RS.TRAUMA

CENTRE 12/02/2016 31/12/2016

24 7-1990583417 PUSKESMAS SEMOWO DS SEMOWO , KEC. PABELAN 5077102987100985


RS.TRAUMA CENTRE 12/02/2016 31/12/2016

25 1500000000336 PUSKESMAS SUMOWONO JL.PAHLAWAN NO.15 KEC SUMOWONO 40575050 DINAS KESEHATAN KAB.SEMARANG


12/02/2016 31/12/2016

26 1500000000343 PUSKESMAS SURUH JL RAYA SURUH PLUMBON KEC SURUH 2882262 DINAS KESEHATAN KAB.SEMARANG


12/02/2016 31/12/2016

27 1500000000342 PUSKESMAS SUSUKAN JL RAYA SUSUKAN NO.96 KEC SUSUKAN 615066DINAS KESEHATAN KAB SEMARANG PER/07/012016

RS.TRAUMA CENTRE 12/02/2016 31/12/2016

28 1500000000344 PUSKESMAS TENGARANJL RAYA SALATIGA SOLO KM 9 KEC. TENGARAN


RS.TRAUMA CENTRE 12/02/2016 31/12/2016

29 7-1990928198 PUSKESMAS TUNTANG JL FATMAWATI NO.47, KEC TUNTANG 501310298340007

DINAS KESEHATAN KAB.SEMARANG


12/02/2016 31/12/2016

30 7-2009013889 PUSKESMAS UNGARAN JL AHMAD YANI NO 2-3 KEC UNGARAN KAB SEMARANG



15/02/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


100 / 15116-05-201607:59:01



IKS


31 1400000000016 RS PURI ASIH JL JEND.SUDIRMAN NO. 169 323209 DR MUFTI SIRADJ,SPOG PER/04/012016 RS.TRAUMA CENTRE 12/01/2016 31/12/2016

32 1400000000019 RSUD AMBARAWA JL KARTINI NO. 101 AMBARAWA 591020 PEMDA KAB SEMARANG PER/02/012016 RS.TRAUMA CENTRE 12/01/2016 31/12/2016

33 7-1395288578 RSUD KOTA SALATIGA JL OSAMALIKI NO. 19 SALATIGA 50721 PEMKOT SALATIGA PER/03/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

34 01728 RSUD SALATIGA JL OSAMALIKI NO 19 SALATIGA 324074 KOTA MAGELANG PER/03/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

35 1400000000018 RSUD UNGARAN JL DIPONEGORO NO. 125 UNGARAN 6921006 PEMDA KAB.SEMARANG PER/01/012016 RS.TRAUMA CENTRE 12/01/2016 31/12/2016

KANTOR CABANG : L11- KANTOR CABANG SEMARANG KALIGAWE


IKS


1 1500000001891KLINIK 24 JAM DELIMA SEHAT JL FATMAWATI NO 21A SEMARANG 50111 6734367 DR. DODI WITJAKSONO PER/15/012016

RS.TRAUMA CENTRE 11/01/2016 31/12/2016

2 1500000001494 KLINIK KAWAN SEJATIDS KARANGSARI RT 01/04 KARANGTENGAHDEMAK

089671458335

NINDYA ANGGI SINANTARA PER/09/012016

RS.TRAUMA CENTRE 11/01/2016 31/12/2016

3 1500000001534KLINIK PRATAMA DWI PUSPITA KALIGAWE

JL. RAYA KALIGAWE KM 7 NO 9 TRIMULYOSEMARANG

082180099759

HJ. ANISFA BAKAR PER/12/012016RS.TRAUMA CENTRE

11/01/2016 31/12/2016

4 1500000001532 KLINIK PRATAMA DWI PUSPITA KARANGAWEN

JL. BRAMBANG NO 217 RT 05/02 BRAMBANG - DEMAK

082180099759

HJ. ANISFA BAKAR PER/10/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


101 / 15116-05-201607:59:01



IKS


5 1500000001533 KLINIK PRATAMA DWI PUSPITA PEDURUNGAN

JL. BRIG.JEND. SUDIARTO NO 512 SEMARANG

082180099759 HJ. ANISFA BAKAR PER/11/012016 RS.TRAUMA

CENTRE 11/01/2016 31/12/2016

6 1400000000261 KLINIK PRATAMA NAYAKA ERA HUSADA 03 JL RAYA KALIGAWE KM5,5 70572297 PT NAYAKA ERA

HUSADA SEMARANG PER/04/012016 RS.TRAUMA CENTRE 11/01/2016 31/12/2016

7 1500000001381 KLINIK PRATAMA NAYAKA HUSADA 04

JL SEMARANG-DEMAK KM 15 WONOKERTOKARANGTENGAH DEMAK

7605621 PT NAYAKA ERA HUSADA SEMARANG


11/01/2016 31/12/2016


JL SULTAN FATAH NO 47 DEMAK 7605621 PT NAYAKA ERA HUSADA SEMARANG


11/01/2016 31/12/2016

9 1500000001807 KLINIK PRATAMA RAWAT INAP KELUARGA SAKINAH

JL TELAGA KENCANA RAYA NO 15 BATURSARI MRANGGEN DEMAK 76580381 DR. AISYAH LAHDJI PER/14/012016 RS.TRAUMA

CENTRE 11/01/2016 31/12/2016

10 1500000001539KLINIK PRATAMA SAYUNG HUSADA DEMAK JL. RAYA SAYUNG KM 10 SAYUNG - DEMAK 6591137 DR. FUAD ALHAMIDY PER/13/012016

RS.TRAUMA CENTRE 11/01/2016 31/12/2016

11 1500000001333 KLINIK PRATAMA SEHAT UTAMA

JL. MEDOHO RAYA NO 21 SAMBIREJO SEMARANG

6719222 HJ. SRI WAHYUNI MAHMUD, AM


11/01/2016 31/12/2016

12 1300000000006 RS ISLAM NU DEMAK (RS TRAUMA CENTER JKK)

JL JOGOLOYO NO 09 DEMAK 685723 DR NUNUK SRI LESTARI PER/02/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

13 1100000000006RS ISLAM SULTAN AGUNG (RS TRAUMA CENTER JKK) JL RAYA KALIGAWE KM 4 SEMARANG 6580019 DR MASYHUDI,MSI PER/01/012016

RS.TRAUMA CENTRE 11/01/2016 31/12/2017

14 1300000000033RS PANTI WILSA CITARUM SEMARANG (RSTC JKK) JL CITARUM NO 98 SEMARANG 3546040 DR SUSETYO, SPA PER/03/012016

RS.TRAUMA CENTRE 11/01/2016 31/12/2016

15 1400000000402RSUD SUNAN KALIJAGA (RSTC)

JL. SULTAN FATAH 669/50 DEMAK 685018 RSUD KAB. DEMAK PER/05/012016RS.TRAUMA CENTRE

11/01/2016 31/12/2016

KANTOR CABANG : N00- KANTOR CABANG SURABAYA KARIMUNJAWA


Periode : 01/01/2016 s/d 31/12/2016


102 / 15116-05-201607:59:01



IKS


1 1500000000715 ANUGERAH KARYA MEDIKACEMENGKALANG SIDOARJO

RUKO PURI INDAH BLOK 30,JATI-CEMENGKALANG-SIDOARJO

03171554259

SUSILO HENDROWARSITO PER/09/012015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

2 1500000000717 ANUGERAH KARYA MEDIKADEMAK JL. DEMAK 375 SURABAYA 081130514

3CV. ANUGERAH KARYA MEDIKA PER/09/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

3 1500000000720 ANUGERAH KARYA MEDIKAGUNUNGSARI

JL. GUNUNGSARI NO.124 SURABAYA 5675589 CV. ANUGERAH KARYA MEDIKA


01/01/2016 31/12/2016

4 1500000000712 BP 14 JL. PUCANG ANOM TIMUR NO. 35 SURABAYA

70701255 DR SURANADI SUGANDA PER/10/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

5 1500000001466 BRAIN CLINIC JL. SULAWESI NO.63 SURABAYA 5018800 PT. NEURO SENTRA HUSADA PER/11/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

6 1500000001030KLINIK ABDI MULIA HR MUHAMMAD

JL HR MOHAMMAD KAV 401-403 SURABAYA 7319619 YAYASAN ABDI MULIA PER/12/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

7 1500000001031 KLINIK ABDI MULIA WISMA PERMAI

JL. WISMA PERMAI BARAT III/FP 12 SURABAYA

031-5944122

YAYASAN ABDI MULIA PER/12/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

8 1500000000719 KLINIK HEALTHY JL NGAGEL TIRTO 25-27 5040990 KLINIK BEDAH & PRAKTEK DR HEALTHY


01/01/2016 31/12/2016

9 1500000001071 KLINIK KENCANA MEDIKA JL. KENDANGSARI NO. 78 SURABAYA 8498880KLINIK KENCANA MEDIKA PER/14/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

10 1500000000716 KLINIK MEDIS AMBENGAN JL.AMBENGAN 35 SURABAYA0818322119

CV. KARYA PUTRA AMBENGAN PER/15/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

11 1500000001072 KLINIK MEDPOINT JL. RAYA LONTAR 229 SURABAYA 7524067 KLINIK MEDPOINT PER/16/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

12 1500000001487 KLINIK MODERN DASA MEDIKA

JL. DIPONEGORO NO 161-163 SURABAYA 5677088PT.PERKEBUNAN NUSANTARA X (PERSERO)


01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


103 / 15116-05-201607:59:01



IKS


13 1400000000445 KLINIK NAYAKA HUSADA 15 JL RAYA KRIKILAN NO 259 DRIYOREJO GRESIK 7887273 PT NAYAKA ERA


14 1400000000450 KLINIK NAYAKA HUSADA 24 JL RA KARTINI NO 236 C-9 KEBOMAS GRESIK 7887273 PT NAYAKA ERA


15 1400000000449 KLINIK NAYAKA HUSADA 61 RUKO SEPANJANG TOWN HOUSE C1-C3 JL KALIJATEN

7887273 PT NAYAKA ERA HUSADA


01/01/2016 31/12/2016

16 1500000000713 KLINIK PRATAMA 65 JL. GUBENG KERTAJAYA X1/38 SURABAYA 08883535666

DR ADRIANUS MICHAEL FOEH


01/01/2016 31/12/2016

17 1500000000718 KLINIK PRATAMA ALAMANDA JL. DINOYO NO.20-II 5677767 CV. INTI PRATAMA PER/17/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

18 1500000000718KLINIK PRATAMA ALAMANDA JL. DINOYO NO.20-II 5677767 CV. INTI PRATAMA PER/19/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

19 1400000000443 KLINIK PRATAMA NAYAKA 02

JL MASTRIP NO 150 KEBRAON SURABAYA 7887273 PT NAYAKA ERA HUSADA


01/01/2016 31/12/2016


JL CENDRAWASIH NO 28B 7887273 PT NAYAKA ERA HUSADA


01/01/2016 31/12/2016

21 1400000000446KLINIK PRATAMA NAYAKA HUSADA 03 JL ASEM ROWO KALI NO 1 7887273


RS.TRAUMA CENTRE 01/01/2016 31/12/2016

22 1400000000447KLINIK PRATAMA NAYAKA HUSADA 05 JL PANDEGILING NO 117A 7887273


RS.TRAUMA CENTRE 01/01/2016 31/12/2016

23 1400000000448KLINIK PRATAMA NAYAKA HUSADA 07

JL TANDES ASRI NO 64 7887273PT NAYAKA ERA HUSADA


01/01/2016 31/12/2016


JL KALI RUNGKUT NO 52 7887273 PT NAYAKA ERA HUSADA


01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


104 / 15116-05-201607:59:01



IKS


25 1500000001483 KLINIK PRATAMA PG KREMBOONG DESA KREMBOONG SIDOARJO 081332074

648 PTPN X PER/06/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

26 1500000001483 KLINIK PRATAMA PG KREMBOONG DESA KREMBOONG SIDOARJO 081332074

648 PTPN X PER/24/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

27 1500000001484 KLINIK PRATAMA PG TOELANGAN

DESA TULANGAN SIDOARJO PTPN X PER/06/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

28 1500000001484 KLINIK PRATAMA PG TOELANGAN

DESA TULANGAN SIDOARJO PTPN X PER/24/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

29 1500000001485 KLINIK PRATAMA PG WATOETOELIS

DESA TEMU KECAMATAN PRAMBON SIDOARJO

081332074648 PTPN X PER/06/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

30 1500000001485KLINIK PRATAMA PG WATOETOELIS

DESA TEMU KECAMATAN PRAMBON SIDOARJO

081332074648 PTPN X PER/24/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

31 1500000001486 KLINIK ST.VINCENTIUS A PAULO (KARAH)

JL. KARAH NO.200 SURABAYA 5677562 YAYASAN ARNOLDUS PER/20/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

32 1500000001029 KLINIK UTAMA KASIH KARUNIA

JL. RAYA SATELIT BARAT AS NO.1 SURABAYA

7327688 YAYASAN KASIH KARUNIA


01/01/2016 31/12/2016

33 7-2646874297 RS ADI HUSADA KAPASARI JL. KAPASARI 97-101 SURABAYA 601410313764555

PERKUMPULAN ADI HUSADA PER/28/032016

RS.TRAUMA CENTRE 24/03/2016 31/12/2016

34 1500000000478RS BHAKTI DHARMA HUSADA JL RAYA KENDUNG NO 115-117 7404444

PEMERINTAH KOTA SURABAYA PER/07/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

35 0700000000013RS BHAYANGKARA HS SAMSOERI M

JL. A YANI NO. 116 SURABAYA 8292227 POLDA JATIM PER/01/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

36 1500000000714 RS MARINIR EWA PANGALILA GUNUNGSARI

JL GOLF I NO 1A SURABAYA 031-5663539

TNI ANGKATAN LAUT PER/02/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


105 / 15116-05-201607:59:01



IKS


37 1500000001385 RS MATA UNDAAN JL UNDAAN KULON 17-19 SURABAYA 5343806 RS MATA UNDAAN PER/22/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

38 1500000000549 RS TINGKAT III BRAWIJAYA JL KESATRIAN NO 17 5611272 KODAM V BRAWIJAYA PER/03/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

39 1500000000187 RS TNI AU SOEMITRO SURABAYA

JL. SERAYU NO 17 SURABAYA 5662593 TNI AU PER/04/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

40 1500000001384 RS UNIVERSITAS AIRLANGGA

KAMPUS C MULYOREJO UNIVERSITAS AIRLANGGA SBY

8439473 UNIVERSITAS AIRLANGGA


01/01/2016 31/12/2016

41 7-2646874299 RS WILLIAM BOOTH SURABAYA JL. DIPONEGORO NO.34 SURABAYA 60241 031567891

7

YAYASAN PELAYANAN KESEHATAN BALA KESELAMATAN


42 1500000000711RS.DKT GUBENG POJOK-BANTUAN 05.08.05 SURABAYA

JL. GUBENG POJOK NO.21 5310069 DRG.OUTI PER/05/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

43 7-2743409383 RSUD DR SOETOMO JL. MAYJEND PROF. DR. MOESTOPO NO. 6 - 8 SURABAYA

60286 5501770-72 PEMPROV JATIM PER/27/032016 RS.TRAUMA CENTRE

31/03/2016 31/12/2016

44 1400000000360 RUMAH SAKIT SURABAYA MEDICAL SERVICE

JL. KAPUAS NO.2 SURABAYA 5686161 YAYASAN PUJA HUSADA PER/23/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

45 7-2884678195SILOAM HOSPITALS SURABAYA JL. GUBENG NO 70 SURABAYA 60281

031 503 1333

PT. SILOAM INTERNATIONAL HOSPITALS SURABAYA


46 1500000001201UPT PELATIHAN KERJA SURABAYA JL.DUKUH MENANGGAL III/29 SURABAYA 8290071 DRS. WIDJIL SAPTADI PER/18/052015

RS.TRAUMA CENTRE 01/01/2016 19/05/2016

KANTOR CABANG : N01- KANTOR CABANG KEDIRI


Periode : 01/01/2016 s/d 31/12/2016


106 / 15116-05-201607:59:01



IKS


1 1000000000008 RS BHAYANGKARA KEDIRI JL.KOMBES POL. DURYAT NO. 17 KEDIRI POLRI PER/24/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

2 1000000000008 RS BHAYANGKARA KEDIRI JL.KOMBES POL. DURYAT NO. 17 KEDIRI POLRI PER/33/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

3 07189 RS BHAYANGKARA NGANJUK

JL. ABDUL RAHMAN SALEH NO. 52-56 3218896 PER/23/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

4 1500000000725 RSU AURA SYIFA JL. JOYOBOYO NO. 42 DLOPO KEC. NGASEMKABUPATEN KEDIRI

671939 RSU AURA SYIFA PER/31/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

5 0800000000031 RSUD GAMBIRAN JL.K.H.WAHID HASYIM NO 64 773097 DR.ENDANG WAHYU L,MARS PER/26/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

6 1500000001542 RSUD KABUPATEN KEDIRIJLN. PAHLAWAN KUSUMA BANGSA NO. 1 PARE KEDIRI 391718

RSUD KABUPATEN KEDIRI PER/29/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

7 1400000000564 RSUD KERTOSONO JL. SUPRIYADI NO. 29 KERTOSONO 551118 RUMAH SAKIT UMUM DAERAH KERTOSONO


01/01/2016 31/12/2016

8 1500000000863 RUMAH SAKIT BEDAH ARGAHUSADA

DS BRANGGAHAN KEC NGADILUWIH KABUPATEN KEDIRI

476376 YAYASAN ARGA HUSADA UTAMA


01/01/2016 31/12/2016

9 1500000000940RUMAH SAKIT HVA TOELOENGREDJO

JL. A YANI NO. 25 PARE KABUPATEN KEDIRI 391047

RS PTP XXI TOELOENGREDJO PER/30/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

10 1400000000206RUMAH SAKIT MUHAMMADIYAH AHMAD DAHLAN

JL. GATOT SUBROTO 84 KOTA KEDIRI 773115MKKM PD MUHAMMADIYAH KOTA KEDIRI


11 1500000000723RUMAH SAKIT MUHAMMADIYAH SITI KHODIJAH

JL. DR.SUTOMO NO.322 SUKOREJO KEC.GURAH KABUPATEN KEDIRI

545481RUMAH SAKIT MUHAMMADIYAH SITI KHODIJAH


01/01/2016 31/12/2016

KANTOR CABANG : N02- KANTOR CABANG MALANG


Periode : 01/01/2016 s/d 31/12/2016


107 / 15116-05-201607:59:01



IKS


1 7-2441622873 G AND G HEALTH CLINIC JLN. TERUSAN KAWI NO. 9 KAV. 9 65119 341 568527 DR. FM. VALENTINA, SH M. HUM PER/16/032016 RS.TRAUMA

CENTRE 11/03/2016 31/12/2016

2 7-2738145733 KLINIK NAYAKA HUSADA NO.05

JLN. RAYA JABUNG RT/ W 003/002 DESA JABUNG KECAMATAN JABUNG 65155 341794735 PT NAYAKA ERA

HUSADA PER/18//032016 RS.TRAUMA CENTRE 30/03/2016 31/12/2016

3 7-2553159943 KLINIK SEHAT24 JLN. RAYA KARANGPLOSO KEPUHARJO RUKO BALITAS KAV. 7

65152 341 5034129

SUJIATI JS PER/17/032016 RS.TRAUMA CENTRE

17/03/2016 31/12/2016

4 1300000000016 RS. BAPTIS BATU JL. RAYA TLEKUNG NO.1 JUNREJO 594161 YAYASAN BAPTIS INDONESIA


01/01/2016 31/12/2016

5 1200000000012 RS. BHAYANGKARA HASTA BRATA JL. RA KARTINI NO. 01 597023 PER/03/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

6 1200000000008 RS. WAVA HUSADAJL. PANGLIMA SUDIRMAN NO. 99 A DILEM KEPANJEN 393000

ABNASAMANHUDI SAUTIKA HUSADA PT PER/11/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

7 1500000000046 RSI GONDANGLEGI JL HAYAM WURUK NO 66 GONDANGLEGI 879047 YAYASAN RS GONDANGLEGI

PER/04/01/012016

RS.TRAUMA CENTRE

01/01/2016 31/12/2016

8 1400000000002 RSU ISLAM MADINAH JL. RAYA SUKOSARI 32 KASEMBON 326688 YAY AL MADINAH PER/12/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

9 1200000000009 RSU. LAWANG MEDIKA JL. DR. CIPTO NO. 08 BEDALI LAWANG 426705 PT. DASA USAHA JAYA PER/05/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

10 1200000000010 RSU. PRASETYA HUSADA JL. RAYA NGIJO NO. 25 KARANG PLOSO 460558 SUJIATI, SST,MM.KES PER/08/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

11 7-3039817013RSUD KANJURUHAN KEPANJEN

JLN. PANJI NOMOR 100 65163 341395041PEMERINTAH KABUPATEN MALANG


25/04/2016 20/12/2016

12 1000000000011 RUMAH SAKIT MARSUDI WALUYO

JL.RAYA MONDOROKO KM 9 SINGOSARI MALANG

458919 DR.KRISTIWI HANGGRIYANI


01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


108 / 15116-05-201607:59:01



IKS


13 1000000000011 RUMAH SAKIT MARSUDI WALUYO

JL.RAYA MONDOROKO KM 9 SINGOSARI MALANG 458919 DR.KRISTIWI

HANGGRIYANI PER/14/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

14 1000000000013 RUMAH SAKIT PANTI NIRMALA JL.KEBALEN WETAN NO.8 331100 DRG.BENNY ANDOKO

WIBISONO PER/ 07/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

15 1000000000012 RUMAH SAKIT PRIMA HUSADA

JL.BANJARARUM SELATAN NO 3 MONDOROKO-SINGOSARI MALANG

458679 DR.SADI HARIONO PER/09/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

16 1200000000011 RUMAH SAKIT UMUM BEN MARI

JL. RAYA KENDAL PAYAK NO 17 PAKISAJI 837777 PT. RS BEN MARI PER/02/012015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

17 1400000000001RUMAH SAKIT UMUM DAERAH DR. SAIFUL ANWAR

JL. JAKSA AGUNG SUPRAPTO 362101 PEMPROV JATIM PER/09/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

18 1400000000001RUMAH SAKIT UMUM DAERAH DR. SAIFUL ANWAR

JL. JAKSA AGUNG SUPRAPTO 362101 PEMPROV JATIM PER/10/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

19 7-1238038834 RUMAH SAKIT UMUM KARSA HUSADA BATU

JLN. A . YANI 10-13 65311 341591036 PROVINSI PER/13/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

20 1500000001316 UPT PELATHAN KERJA SINGOSARI

JL. RAYA SINGOSARI 458055 UPT PELATHAN KERJA SINGOSARI


04/02/2016 31/12/2016

KANTOR CABANG : N03- KANTOR CABANG JEMBER


IKS


1 1400000000625 RS BHAYANGKARA BONDOWOSO

JL JEND POL SUCIPTO JUDODIHARJO NO 12 BONDOWOSO

082336624828

DR EKA WARDHANI PER/22/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


109 / 15116-05-201607:59:01



IKS


2 1500000001561 RS BHAYANGKARA TK III LUMAJANG

JL KYAI ILYAS NO 07 TOMPOKERSAN LUMAJANG 88646 POLDA JATIM PER/10/062015 RS.TRAUMA

CENTRE 01/06/2016 31/05/2017

3 7-1672273183 RS CITRA HUSADA JL. TERATAI NO. 22 DS. GEBANG KEC. PATRANG KOTA JEMBER 68117 033148620

0YAYASAN CITRA HUSADA PER/4/012016 RS.TRAUMA

CENTRE 01/02/2016 31/12/2016

4 7-1672273183 RS CITRA HUSADA JL. TERATAI NO. 22 DS. GEBANG KEC. PATRANG KOTA JEMBER

68117 0331486200

YAYASAN CITRA HUSADA


01/02/2016 31/01/2017

5 1400000000626 RS ISLAM LUMAJANG JL KYAI MUKSIN 19 LUMAJANG 887999 DR R ELYUNAR DWI NUGROHO


01/01/2016 31/12/2016

6 7-1692033973 RS JEMBER KLINIK JALAN BEDADUNG NO.2 JEMBER LOR PATRANG JEMBER 68111 033148710

4 PT NUSANTARA MEDIKAUTAMA PER/05/012016 RS.TRAUMA

CENTRE 28/01/2016 31/12/2016

7 1500000000647 RSD DR SOEBANDI JL DR SOEBANDI NO 124 487441 PER/09/2016RS.TRAUMA CENTRE 01/04/2016 31/12/2017

8 1400000000009 RSU KALIWATES JEMBER JL DIAH PITALOKA NO 4 A JEMBER 485967 PT ROLAS NUSANTARA MEDIKA


01/01/2016 31/12/2016

9 7-1938064553 RSUD DR HARYOTO KAB LUMAJANG

JL BASUKI RAHMAD NO 5 LUMAJANG 67311 0334881666

PEMPROV PER/007/022016 RS.TRAUMA CENTRE

22/02/2016 31/12/2016

KANTOR CABANG : N04- KANTOR CABANG PASURUAN


IKS


1 1500000001062 BP JAMSOSTEK 22 JL. PUCANGSARI, SENGONAGUNG, PURWOSARI

7764043 CV CITRA MEDIKA IKS/09/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


110 / 15116-05-201607:59:01



IKS


2 1500000001061 BP JAMSOSTEK 51 JL. TONGKOL NO. 2C, BANGIL 747731 CV CITRA MEDIKA IKS/10/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

3 1500000001336 KLINIK CITRA 10 JL. RAYA JAPANAN, GG.BANDENG PRESATO NO.2, GEMPOL 854335 CV CITRA MEDIKA IKS/11/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

4 1500000001340 KLINIK CITRA 2 JL. RAYA DRINGU GG.MARGOMULYO NO.2 843346 CV CITRA MEDIKA IKS/15/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

5 1500000001339 KLINIK CITRA 6 JL. MASTRIP GG.KELAPA GADING NO. 43 4430181 CV CITRA MEDIKA IKS/14/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

6 1500000001338 KLINIK CITRA PURWOSARI JL. RAYA PURWOSARI NO. 21, 612244 CV CITRA MEDIKA IKS/13/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

7 1500000001337 KLINIK JAMSOSTEK CITRA 1 JL. RAYA NGOPAK NO. 8, REJOSO 482366 CV CITRA MEDIKA IKS/12/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

8 1500000001045 KLINIK MITRA 125 GG LONDO NO. 22A, JAGIL, GAMBIRAN, PRIGEN

881459 CV MITRA HUSADA IKS/08/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

9 1500000001040 KLINIK MITRA 82RUKO PERUM ISTANA BESTARI, JL. DR. WAHIDIN SUDIROHUSODO KEL. TAMANAN,KEC. BUGUL KIDUL,

6640508 CV. MITRA HUSADA IKS/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

10 1500000001044 KLINIK MITRA 91 JL. RAYA GONDANG LEGI NO. 04, BEJI 655291 CV MITRA HUSADA IKS/07/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

11 1500000001043 KLINIK MITRA 95 JL. STADION 28 PANDAAN / JL. PATTIMURA 636028 CV MITRA HUSADA IKS/06/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

12 1500000001052KLINIK RAWAT INAP ISLAM AISYIYAH

JL. PAHLAWAN SUNARYO 257, KUTOREJO, PANDAAN

637367 IKS/04/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

13 1500000001233 RS RIZANI HUSADA JL. RAYA KOTAANYAR NO. 42 773444 PT RIZANI HUSADA IKS/16/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


111 / 15116-05-201607:59:01



IKS


14 1400000000264 RSI MASYITHOH JL. A. YANI NO. 6-7, BANGIL 741018 YAYASAN IKS/01/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

15 1500000000087 RSUD TONGAS JL RAYA TONGAS 229 511836 DRG KAMALIYAH TJIPLUK P.L, MMKES IKS/02/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

KANTOR CABANG : N05- KANTOR CABANG MOJOKERTO


IKS


1 1500000001601 BP JAMSOSTEK 106 JL RAYA WONOSARI NO 112 NGORO 61385 6817998 IR H TEUKU ISMAIL PER/48/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

2 1500000000346 KLINIK ASY-SYIFA JL RAYA PLOSO DS REJOAGUNG KEC PLOSO

61453 885995 DR ELDYANTO YUYUN PER/55/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

3 1500000001603 KLINIK CITA MULIA PERUM WIKARSA BLOK G NO1 KENANTEN PURI

61311 323302 CV GALUH MERALDA PER56/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

4 1500000001606 KLINIK EMMA JL JETIS TAMA NO 3 GRIYA JETIS PERMAI 61352CV BANGUN SESAMA DAMAI SEJAHTERA PER/46/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

5 1400000000107 KLINIK INDUSTRI MEDIKARUKO NGORO INDUSTRI PERSADA KAV A4-A6 61385 6817979

MARIA MEILITASARI HARLIN DR, SPPD, MARS PER/54/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

6 1500000001597KLINIK KELUARGA BAHAGIA

JL RAYA BADUNG DSN BADUNG DS KEDUNGLENGKONG

61371 513355NOVEL MOHAMMAD RAMZY PUTRA


01/01/2016 31/12/2016

7 1500000001604 KLINIK MITRA 14 PERAK DSN GADING DS GADINGMANGU KEC PERAK

61461 DR WARTIK PER/51/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


112 / 15116-05-201607:59:01



IKS


8 1500000001607 KLINIK MITRA 39 JL RAYA DIWEK NO 39 KEC DIWEK 61471 DR BETTY ENDAH WARNI MKES PER/53/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

9 1500000001598 KLINIK PRATAMA MITRA 12 JL ANGGREK NO 24 CANDIMULYO 61411 878318 DR MERIDIAN GEODESI PER/47/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

10 1500000001605 KLINIK PRATAMA MITRA 26 JL PANGLIMA SUDIRMAN NO 26 KEC PLOSO 61453 DR WIWIET SARASWATI PER/52/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

11 1500000001599 KLINIK PRATAMA MITRA 38 JL RAYA TROWULAN NO132 KEC TROWULAN

61362 492876 CV MITRA HUSADA PER/49/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

12 1500000001600 KLINIK PRATAMA MITRA 47 JL RAYA JETIS NO 14 61352 363786 IR H TEUKU ISMAIL PER/50/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

13 1500000001595KLINIK PRATAMA SURYA HUSADA 2

JL RAYA PRAMBON DS NGIMBANG MOJOSARI 61384

SITI NUR HIDAYATI ST MKES PER/44/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

14 1500000001596 KLINIK SURYA HUSADA RAYA TRAWAS DSN WRINGINANOM DS MOJOREJO

61384 SITI NUR HIDAYATI ST MKES


01/01/2016 31/12/2016

15 1500000001608 RS AL AZIZ JL RAYA TEMBELANG KEC TEMBELANG 61453 853757 YAYASAN AL AZIZ PER/67/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

16 0900000000027 RS EMMA (RS TC) JL RAYA IJEN NO 67 613110321328737

DR MAGDALENA SITORUS PER/64/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

17 1500000000353 RS GATOELJL RADEN WIJAYA NO 56 KRANGGAN, PRAJURIT KULON 61319 328557

PT NUSANTARA MEDIKA UTAMA PER/63/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

18 1500000000927 RS KAMAR MEDIKAJL EMPUNALA NO 351 KEDUNDUNG MAGERSARI

330066PT WAK KAMAR MEDIKAHOSPITAL


20/01/2016 31/12/2016

19 1500000000925 RS MUTIARA HATI JL RAYA KEMANTREN WETAN NO 49 TERUSAN GEDEG

61351 363442 SULFAKAR DR SPOG PER/66/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


113 / 15116-05-201607:59:01



IKS


20 1500000001594 RS NAHDLATUL ULAMA JOMBANG JL KH HASYIM ASYARI NO 211 878700

PT RUMAH SAKIT NAHDLATUL ULAMA JOMBANG


21 1500000001522 RS PELENGKAP MEDICAL CENTER JL IR JUANDA NO 03 61411 877945 PT PELANGKAP MEDICA

SEJAHTERA PER/68/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

22 0800000000011 RS SIDO WARAS (RS TC) JL RAYA PASAR SAWAHAN KM 10 BANGSAL

61381 598621 DR MARIA M HARLIM SP.PD


01/01/2016 31/12/2016

23 0800000000034 RSI AROFAH (RS TC) JL. GAJAH MADA NO.1 MOJOSARI 61382 596900 DR HR SETIOHARTONO PER/62/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

24 1500000001523 RSI HASANAH JL HOS COKROAMINOTO NO 26-28 MOJOKERTO 321635

PIMPINAN WILAYAH MUHAMMADIYAH JAWA TIMUR


25 1500000001621 RSI JOMBANG JL BRIGJEN KRETARTO NO 22 A 61411 860074

YAYASAN AMAL SHOLEH IKATAN PERSAUDARAAN HAJI INDONESIA


26 0800000000033 RSI SAKINAH (RS TC) JL R A BASUNI NO 12 61361 321922 DR SULAIMAN ROSYID PER/61/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

27 0800000000010 RSUD. PROF. DR. SOEKANDAR (RS TC)

JL HAYAM WURUK NO 25 MOJOSARI 61382 591591 PER/59/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

28 1500000000347RUMAH SAKIT KRISTEN MOJOWARNO JL MERDEKA NO 59 MOJOWARNO 61475 495093

YAYASAN KESEHATAN GKJW PER/57/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

KANTOR CABANG : N06- KANTOR CABANG BANYUWANGI


Periode : 01/01/2016 s/d 31/12/2016


114 / 15116-05-201607:59:01



IKS


1 1500000000827 KLINIK BRAWIJAYA JL BRAWIJAYA NO 46 KEBALENAN 423711 DR EDI HERMANTO PER/07/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

2 1500000000832 KLINIK KHADIJAH PKU MUHAMMADIYAH MUNCAR JL BRAWIJAYA 23A MUNCAR 592890

PIMPINAN CABANG MUHAMMADIYAH MUNCAR


3 7-1989906563 RS NAHDLATUL ULAMA BANYUWANGI

JL RAYA MANGIR NO 09 KEC ROGOJAMPI 68462 632965000PC NAHDLATUL ULAMA KABUPATEN BANYUWANGI


11/02/2016 31/12/2016

4 1200000000005 RS YASMIN JL LETKOL ISTIQLAH 80-84 421198 YAYASAN SUMBER WARAS


01/01/2016 31/12/2016

5 1400000000010 RSU BHAKTI HUSADA KRIKILAN KRIKILAN GLENMORE 821118 PT ROLAS NUSANTARA

MEDIKA PER/02/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

6 1500000001552RSUD ASEMBAGUS SITUBONDO

JL RAYA ASEMBAGUS KECAMATAN ASEMBAGUS 452193 PER/06/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

7 1500000001392 RSUD BESUKI JL OLAHRAGA NO 55 BESUKI 891118 PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

8 1400000000672 RSUD BLAMBANGAN BANYUWANGI

JL LETKOL ISTIQLAH BANYUWANGI 421118 PEMDA BANYUWANGI PER/03/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

9 1500000000826RSUD GENTENG BANYUWANGI JL HASANUDDIN NO 98 GENTENG 845839 PER/04/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

10 1500000001576UPT PELATIHAN KERJA SITUBONDO JL BASUKI RAHMAT NO 357 672054 PER/09/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

KANTOR CABANG : N07- KANTOR CABANG MADIUN


Periode : 01/01/2016 s/d 31/12/2016


115 / 15116-05-201607:59:01



IKS


1 1500000000786 PUSKESMAS BALEREJO JL RAYA MADIUN SURABAYA NO 82 DS BALEREJO KEC BALEREJO 383798 PER/16/092016 RS.TRAUMA

CENTRE 13/05/2016 31/12/2017

2 1500000000774 PUSKESMAS BANGUNSARI JL PANJANG PUNJUNG DS DOLOPO KEC.DOLOPO 368601 PER/16/052016 RS.TRAUMA

CENTRE 13/05/2016 31/12/2017

3 1500000000938 PUSKESMAS BANJAREJO JL. BAYANGKARA NO.1 KEL BANJAREJO KEC. TAMAN


13/05/2016 31/12/2017

4 1500000000780 PUSKESMAS DAGANGAN JL RAYA DAGANGAN PAGOTAN NO 57 DS DAGANGAN KEC DAGANGAN


13/05/2016 31/12/2017

5 1500000000939 PUSKESMAS DEMANGAN JL. SOEKARNO HATTA NO. 47 KEL. DEMANGAN KEC. TAMAN 464308 PER/17/05/2016 RS.TRAUMA

CENTRE 13/05/2016 31/12/2017

6 1500000000784 PUSKESMAS DIMONGJL RAYA DIMONG DS DIMONG KEC MADIUN 458123 PER/16/052016

RS.TRAUMA CENTRE 13/05/2016 31/12/2017

7 1500000000777 PUSKESMAS GANTRUNG JL RAYA DOLOPO DS SIDOREJO KEC.KEBONSARI


13/05/2016 31/12/2017

8 1500000000778 PUSKESMAS GEGER JL RAYA PONOROGO NO 48 DS PURWOREJOKEC GEGER


13/05/2016 31/12/2017

9 1500000000794 PUSKESMAS GEMARANGJL TGP NO 17 DS GEMARANG KEC GEMARANG PER/16/052016

RS.TRAUMA CENTRE 13/05/2016 31/12/2017

10 1500000000781 PUSKESMAS JETIS JL JETIS DS JETIS KEC DAGANGAN 367664 PER/16/052016RS.TRAUMA CENTRE 13/05/2016 31/12/2017

11 1500000000782 PUSKESMAS JIWAN JL RAYA SOLO NO 85 DS JIWAN KEC.JIWAN 465023 PER/16/052016RS.TRAUMA CENTRE

13/05/2016 31/12/2017

12 1500000000779 PUSKESMAS KAIBON JL PANCOTARUNO NO 407 DS KAIBON KEC GEGER


13/05/2016 31/12/2017


Periode : 01/01/2016 s/d 31/12/2016


116 / 15116-05-201607:59:01



IKS


13 1500000000795 PUSKESMAS KARE JL RAYA RANDU ALAS KARE KEC KARE 3406616 PER/16/05/2016 RS.TRAUMA CENTRE 13/05/2016 31/12/2017

14 1500000000776 PUSKESMAS KEBONSARI JL UTERAN KEBONSARI NO 13 DS SINGGAHAN KEC KEBONSARI 367991 PER/16/052016 RS.TRAUMA

CENTRE 13/05/2016 31/12/2017

15 1500000000799 PUSKESMAS KLAGENSERUT JL RAYA KLAGEN SERUT KEC JIWAN 499761 PER/16/052016 RS.TRAUMA CENTRE

13/05/2016 31/12/2017

16 1500000000798 PUSKESMAS KLECOREJO JL RAYA WATES DS KLECOREJO KEC MEJAYAN


13/05/2016 31/12/2017

17 1500000000791 PUSKESMAS KREBET JL GAWANG UTARA DS KREBET KEC.PILANGKENCENG PER/16/052016 RS.TRAUMA

CENTRE 13/05/2016 31/12/2017

18 1500000000783 PUSKESMAS MADIUNJL RAYA PUSKESMAS NO 9 DS TIRON KEC MADIUN 458271 PER/16/052016

RS.TRAUMA CENTRE 13/05/2016 31/12/2017

19 1500000000936 PUSKESMAS MANGUHARJO JL. GAJAHMADA NO. 124 KEL. MANGUHARJO KEC. MANGUHARJO


13/05/2016 31/12/2017

20 1500000000789 PUSKESMAS MEJAYAN JL PANGLIMA SUDIRMAN NO 52 DS MEJAYAN KEC.MEJAYAN


13/05/2016 31/12/2017

21 1500000000775 PUSKESMAS MLILIRJL RAYA MADIUN PONOROGO NO 06 MLILIR KEC DLOPO 368098 PER/16/052016

RS.TRAUMA CENTRE 13/05/2016 31/12/2017

22 1500000000797 PUSKESMAS MOJOPURNOJL RAYA DUNGUS DS MOJOPURNO KEC WUNGU PER/16/052016

RS.TRAUMA CENTRE 13/05/2016 31/12/2017

23 1500000000934PUSKESMAS ORO - ORO OMBO

JL. DIPONEGORO NO. 22 KEL. ORO-ORO OMBO KEC KARTOHARJO

464402 PER/17/052016RS.TRAUMA CENTRE

13/05/2016 31/12/2017

24 1500000000937 PUSKESMAS PATIHAN JL. MENDUT NO.1 KEL. PATIHAN KEC. MANGUHARJO


13/05/2016 31/12/2017


Periode : 01/01/2016 s/d 31/12/2016


117 / 15116-05-201607:59:01



IKS


25 1500000000790 PUSKESMAS PILANG KENCENG

JL RAYA KENONGO REJO NO 774B DS KENONGOREJO KEC PILANGKENCENG 383536 PER/16/05/2016 RS.TRAUMA

CENTRE 13/05/2016 31/12/2017

26 1500000000792 PUSKESMAS SARADAN JL RAYA SARADAN DS SUGIHWARAS KEC SARADAN PER/16/052016 RS.TRAUMA

CENTRE 13/05/2016 31/12/2017

27 1500000000785 PUSKESMAS SAWAHAN JL RAYA KAJANG DS KAJANG KEC SAWAHAN


13/05/2016 31/12/2017

28 1500000000787 PUSKESMAS SIMO JL RAYA BALEREJO-MUNENG NO 96 DS SIMO KEC BALEREJO


13/05/2016 31/12/2017

29 1500000000793 PUSKESMAS SUMBERSARI JL RAYA TULUNG NO 05 DS SUMBERSARI KEC SARADAN 384456 PER/16/052016 RS.TRAUMA

CENTRE 13/05/2016 31/12/2017

30 1500000000935 PUSKESMAS TAWANGREJOJL. TAWANGSARI NO. 39 KEL. TAWANGREJO KEC. KARTOHARJO 483997 PER/17/052016

RS.TRAUMA CENTRE 13/05/2016 31/12/2017

31 1500000000788 PUSKESMAS WONOASRI RAYA WONOASRI DS WONOASRI KEC WONOASRI


13/05/2016 31/12/2017

32 1500000000796 PUSKESMAS WUNGU JL RAYA KARE NO 113 DS WUNGU KEC WUNGU


13/05/2016 31/12/2017

33 1400000000150 RSI SITI AISYAH MADIUN JL MAYJEND SUNGKONO NO 38 464822 PP MUHAMMADIYAH PER/18/052016RS.TRAUMA CENTRE 13/05/2016 31/12/2017

34 1400000000149 RSU DARMAYU JL. DR. SUTOMO NO. 44 481320PT DARMAYU PURI KENCANA PER/19/052016

RS.TRAUMA CENTRE 13/05/2016 31/12/2017

35 7-3349569013 RSUD KOTA MADIUN JL CAMPURSARI NO 12B 631510351481314

PEMERINTAH KOTA MADIUN


13/05/2016 31/12/2016

KANTOR CABANG : N08- KANTOR CABANG BLITAR


Periode : 01/01/2016 s/d 31/12/2016


118 / 15116-05-201607:59:01



IKS


1 7-3033275153 KLINIK PRATAMA RAWAT INAP ABA HUSADA JL RAYA KARANGAN KM 7 66361 035579583

1DR. MOKH ROFIQ HINDIONO,MMRS PER/07/042016 RS.TRAUMA

CENTRE 25/04/2016 31/12/2017

2 1400000000148 RSU AMINAH BLITAR JL VETERAN NO.39 KOTA BLITAR 66113 816304 YAY. RUMAH SAKIT AMINAH BLITAR PER/09/052016 RS.TRAUMA

CENTRE 02/05/2016 31/12/2017

3 07732 RSU AN-NISAA JL.SUPARYONO NO.1 TALUN 692999 SRI MUNTAMAH PER/05/042016 RS.TRAUMA CENTRE

01/04/2016 31/12/2017

4 7-1579046012 RSUD MARDI WALUYO JL KALIMANTAN NO 113 66133 (0342)801118

PEMKOT BLITAR PER/02/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

5 7-1575901783 RSUD NGUDI WALUYO WLINGI JL DR SOECIPTO NO 5 66184 034269100

6 PEMKAB BLITAR PER/01/012016 RS.TRAUMA CENTRE 25/01/2016 31/12/2016

KANTOR CABANG : N09- KANTOR CABANG MADURA


IKS


1 1400000000233 PUSKESMAS TLANAKAN JL RAYA TLANAKAN PAMEKASAN 325568 PUSKESMAS PER/01/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

2 1400000000437 RS LUKAS BANGKALAN JL KH MOCH KHOLIL 36A BANGKALAN 3095148 PHILIP PER/04/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

3 1400000000436RSUD DR H MOH ANWAR SUMENEP

JL DR CIPTO NO 42 SUMENEP 662494 PER/03/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

4 1500000000235 RSUD SAMPANG JL RAJAWALI NO 10 323956 PER/02/022016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


119 / 15116-05-201607:59:01



IKS


5 1400000000520 RSUD SYARIFAH AMBAMI RATO EBO BANGKALAN JL PEMUDA KAFFA NO. 9 BANGKALAN 3095088 PER/05/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

KANTOR CABANG : N10- KANTOR CABANG BOJONEGORO


IKS


1 1300000000045 RS DR. SUYUDI PACIRAN LAMONGAN

JL RAYA DEANDELES KECAMATAN PACIRAN 661412 DR DENNY AVIANTO SPD PER/20/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

2 1300000000047RS NAHDLATUL ULAMA (NU) TUBAN JL LETDA SUCIPTO NO 211 328244

DR DIDIK SUHARSOYO MM MARS PER/21/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

3 7-2471813999 RSUD NGIMBANG JL. RAYA BABAT - JOMBANG NO. 227, SENDANGREJO, NGIMBANG LAMONGAN

62273 DR. TAUFIK HIDAYAT PER/1/012013 RS.TRAUMA CENTRE

11/03/2016 31/12/2016

4 1500000000747 RSUD. DR. KOESMA TUBAN JL WAHIDIN SUDIRO HUSODO NO 800 321010 DR. H ZAINUL ARIFIN, SPPK


01/05/2016 31/12/2017

5 1500000000517RSUD.DR.SOEGIRI. LAMONGAN JL. KUSUMA BANGSA NO.7 321718

DR. YULIARTO DWI MARTONO, MMKES PER/4/042016

RS.TRAUMA CENTRE 06/04/2016 31/12/2017

KANTOR CABANG : N11- KANTOR CABANG SIDOARJO


IKS


1 7-3207037624 KLINIK ASY SYIFA PPDFP JL RAYA BENDOMUNGAL SIDOREJO KRIAN 61214YAYASAN DALILUL FALIHIN PONPES DARUL FALAH PUSAT


09/05/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


120 / 15116-05-201607:59:01



IKS


2 1500000000172KLINIK PRATAMA RAWAT JALAN & RAWAT INAP "BDS TEBEL" 24 JAM

JL TEBEL BARAT NO 1-3 8911555 PER/01/022016 RS.TRAUMA CENTRE 18/04/2016 31/12/2016

3 1500000001401 PUSKESMAS BALONGBENDO

JL MAYJEN BAMBANG SUWONO NO 11 SEDURI PER/26/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

4 1500000001372 PUSKESMAS BARENGKRAJAN

DS BARENGKRAJAN KEC KRIAN PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

5 1500000001363 PUSKESMAS BUDURAN JL JAWA NO 2 KEC BUDURAN PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

6 1500000001354 PUSKESMAS CANDI JL M RIDWAN NO 5 GELAM KEC CANDI PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

7 1500000001368 PUSKESMAS GANTING JL SINGO MENGGOLO NO 1 DS GANTING PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

8 1500000001367 PUSKESMAS GEDANGAN JL RAYA GEDANGAN 330 KEC GEDANGAN PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

9 1500000001352 PUSKESMAS JABON JL DUKUH SARI KEC JABON PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

10 1500000001346 PUSKESMAS KEDUNG SOLO DS KEDUNG SOLO KEC PORONG PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

11 1500000001356 PUSKESMAS KEPADANGAN DS KEPADANGAN KEC TULANGAN PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

12 1500000001344 PUSKESMAS KREMBUNG JL SUNGAI KAPUAS NO 2 KEC KREMBUNG PER/26/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

13 1500000001371 PUSKESMAS KRIAN JL SETIA BUDI KEC KRIAN PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


121 / 15116-05-201607:59:01



IKS


14 1500000001366 PUSKESMAS MEDAENG JL JOYOBOYO 40 MEDAENG KEC WARU PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

15 1500000001345 PUSKESMAS PORONG JL JUWET UTARA 265 KEC PORONG PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

16 1500000001343 PUSKESMAS PRAMBON JL RAYA PRAMBAON KEC PRAMBON PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

17 1500000001364 PUSKESMAS SEDATI DS BETRO KEC SEDATI PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

18 1500000001361 PUSKESMAS SEKARDANGAN JL WIJAYA KUSUMA NO 91 SEKARDANGAN PER/26/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

19 1500000001359 PUSKESMAS SIDOARJO JL DR SOETOMO NO 14 KEC SIDOARJO PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

20 1500000001358 PUSKESMAS SUKODONO DS PEKARUNGAN KEC SUKODONO PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

21 1500000001369 PUSKESMAS TAMAN JL RAYA NGELOM 50 KEC TAMAN PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

22 1500000001353PUSKESMAS TANGGULANGIN

JL RAYA PUTAT NO 38 KEC TANGGULANGIN PER/26/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

23 1500000001342 PUSKESMAS TARIK JL RAYA KEMUNING KEC TARIK PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

24 1500000001370 PUSKESMAS TROSOBO JL RAYA TROSOBO KEC TAMAN PER/26/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

25 1500000001355 PUSKESMAS TULANGAN JL RAYA KEMANTREN KEC TULANGAN PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


122 / 15116-05-201607:59:01



IKS


26 1500000001360 PUSKESMAS URANGAGUNG JL RAYA CEMENG KALANG KEC SIDOARJO PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

27 1500000001365 PUSKESMAS WARU JL BARITO POJOK NO 1 WISTROP KEC WARU PER/26/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

28 1500000001357 PUSKESMAS WONOAYU JL WONOAYU KEC WONOAYU PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

29 1400000000128 RS BUNDA SIDOARJO JL KUNDI NO 70 KEPUH KIRIMAN WARU 8668880 PT PERMATA BUNDA BERSAMA


01/01/2016 31/12/2016

30 0800000000036 RS CITRA MEDIKA JL.RAYA SURABAYA-MOJOKERTO KM 44 361000 PER/21/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

31 1300000000030 RS SITI KHODIJAH JL PAHLAWAN NO 260 SEPANJANG 7882123 YYS MUHAMMADIYAH PER/23/12205RS.TRAUMA CENTRE 01/01/2016 31/12/2016

32 7-3200248883 RSIA ARAFAH ANWAR MEDIKA SUKODONO

JL SAWO NO 2 SUKODONO 61258 0318830989

DR ISKANDAR ALI PER/08/052016 RS.TRAUMA CENTRE

09/05/2016 31/12/2016

33 1400000000278 RSU ANWAR MEDIKA JL RAYA BY PASS KRIAN KM 33 BALONGBENDO

8974943 YAYASAN RUMAH SAKITANWAR MEDIKA


01/01/2016 31/12/2016

34 1200000000014 RSU JASEM JL KH SAMANHUDI NO 85 8962129YAYASAN USADA KARYA PER/24/122015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

35 0700000000008 RSUD SIDOARJO JL MAJAPAHIT NO 667 8961649 PER/20/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

KANTOR CABANG : N12- KANTOR CABANG GRESIK


Periode : 01/01/2016 s/d 31/12/2016


123 / 15116-05-201607:59:01



IKS


1 1500000000811 BP PANGLIMA SUDIRMAN GRESIK JL PANGLIMA SUDIRMAN 085631864

35 YUNI HIDAYATI PER/12/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

2 1500000001618 FKTP POLRES GRESIK JL BASUKI RAHMAT 2 GRESIK DR. BUDIYONO, MARS PER/14/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

3 1500000000810 KLINIK HIDAYAH MANYAR MANYAR RESORT 08563186435

YUNI HIDAYATI PER/11/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

4 1400000000627 KLINIK KELUARGA BAHAGIA

JL. RAYA WRINGINANOM KM.33.6 81180888 NOVEL MUHAMMAD RAMZY


01/01/2016 31/12/2016

5 1500000000893 PUSKESMAS ALUN ALUN GRESIK JL. PAHLAWAN GRESIK 3981865 DR. ACH SYAFI'I PER/05/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

6 1500000001569PUSKESMAS BALONGPANGGANG GRESIK

RAYA KEDUNGPRING 8 BALONGPANGGANG GRESIK 7921007 DR RINI SULISTYOASIH PER/05/012015

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

7 1500000001572 PUSKESMAS BENJENG GRESIK

JL. RAYA NYAYAT 34 BENJENG GRESIK 7921167 DR SONY PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

8 1500000001492 PUSKESMAS BUNGAH GRESIK

JL RAYA BUNGAH 15 GRESIK 3949600 DRG TITY KARYATI PANIGORO


01/01/2016 31/12/2016

9 1500000000757 PUSKESMAS CERME GRESIK JL RAYA CERME KIDUL 52 CERME 7990007 DR LESTARI PER/05/012015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

10 1500000001573PUSKESMAS DADAP KUNING GRESIK JL. RAYA DADAP KUNING 32 GRESIK 7990510 DR GATOT PURNOMO PER/05/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

11 1500000001570 PUSKESMAS DAPET GRESIKRAYA TANAH LENDEAN 49 BALONGPANGGANG GRESIK

70953980 DR SOESILO PER/05/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

12 1500000000741 PUSKESMAS DRIYOREJO GRESIK

RAYA DRIYOREJO GRESIK 23264794 DR DANIEL SA'U PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


124 / 15116-05-201607:59:01



IKS


13 1500000001571 PUSKESMAS DUDUK SAMPEYAN GRESIK

RAYA DUDUK SAMPEYAN 45 DUDUK SAMPEYAN GRESIK 3903118 DRG NANIK LESTARI PER/05/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

14 1500000001489 PUSKESMAS DUKUN GRESIK JL RAYA SEMBUNGAN KIDUL 37 DUKUN GRESIK 3949299 DRG SAIFUDIN GOZALI PER/05/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

15 1500000000742 PUSKESMAS GENDING GRESIK

JL VETERAN GRESIK 3985872 DRG HELENA SUZANA PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

16 1500000000892 PUSKESMAS INDUSTRI GRESIK

JL. ARIEF RAHMAN HAKIM 100 GRESIK 3985877 DRG ANISAH MAHMUDAH


01/01/2016 31/12/2016

17 1500000000890 PUSKESMAS KARANGANDONG GRESIK

RAYA KARANGANDONG DRIYOREJO GRESIK 7911659 DR SITI HAFIDA PER/05/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

18 1500000000894PUSKESMAS KEBOMAS GRESIK JL SUNAN GIRI III/1 GRESIK 3985880

DR. RAHAJU NUGRAHANI PER/05/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

19 1500000000755 PUSKESMAS KEDAMEAN GRESIK

RAYA KEDAMEAN NO 1 GRESIK 7911437 DR. HILDA BETSY PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

20 1500000001565 PUSKESMAS KEPATIHAN GRESIK

RAYA KEPATIHAN 151 7991403 DRG TITIEK SRI HAJATI PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

21 1500000001566PUSKESMAS KESAMBEN KULON GREIK

KESAMBEN KULON WRINGINANOM GRESIK 60438431 SIDIK NURDIJANTO, SKM PER/05/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

22 1500000001617PUSKESMAS MANYAR GRESIK JL RAYA MANYAR 1 GRESIK DRG JON SUDIRO PER/05/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

23 1500000000756PUSKESMAS MENGANTI GRESIK

JL RAYA MENGANTI 225 MENGANTI 7911360 DRG TJAHYONO EDY W PER/05/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

24 1500000001490 PUSKESMAS MENTARAS GRESIK

JL. RAYA MENTARAS DUKUN GRESIK 70954039 DR. RIZAUL FALAH PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


125 / 15116-05-201607:59:01



IKS


25 1500000001568 PUSKESMAS METATU GRESIK JL. RAYA METATU 1 GRESIK 7991220 EKO HARIANTO, SKM PER/05/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

26 1500000001564 PUSKESMAS NELAYAN GRESIK JL. GUB SURYO 33 GRESIK 3983036 DRG PEKIK PITA M PER/05/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

27 1500000001488 PUSKESMAS PANCENG GRESIK

JL RAYA PANCENG GRESIK 3940118 DR. JAIMAN PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

28 1500000001560 PUSKESMAS SEKAPUK GRESIK

JK RAYA DS SEKAPUK 15 UJUNG PANGKAH GRESIK

3948128 DR MUJTAHIDAH PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

29 1500000001563 PUSKESMAS SEMBAYAT GRESIK JL. PENDOPO NO 1 SEMBAYAT GRESIK 3949800 DR TITIK ERNA PER/05/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

30 1500000001491PUSKESMAS SIDAYU GRESIK JL KANJENG PANGERAN 1 GRESIK 3949100 DR WIWIK SUSANTI PER/05/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

31 1500000001567 PUSKESMAS SLEMPIT GRESIK

RAYA SLEMPIT KEDAMEAN GRESIK 7911963 DR. SUKADI PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

32 1500000000175 PUSKESMAS SUKOMULYO JL. KALIMANTAN NO.104 GKB GRESIK 3954818 DR LESTARI PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

33 1500000001562PUSKESMAS UJUNG PANGKAH GRESIK JL SITARDA 14 PANGKAH GRESIK 3944760 DR SETYORINI PER/05/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

34 1500000000889PUSKESMAS WRINGINANOMGRESIK

RAYA WRINGINANOM 111 WRINGINANOM GRESIK 8975330 DR BUDI LUHUR PER/05/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

35 1500000000808 RACHMIE CLINIC CERME JL RAYA GURANGANYAR NO 23 CERME 331284499DR. RAHMI ZUBAIDAH, SP.MK


01/01/2016 31/12/2016

36 1500000000807 RACHMIE CLINIC DUDUK SAMPEYAN

RUKO D RAYA REGENCY R1 DUDUK SAMPEYAN GRESIK

331284499 DR RAHMI ZUBAIDAH, SPMK


01/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


126 / 15116-05-201607:59:01



IKS


37 1500000001983 RS FATHMA MEDIKA JL. PENDOPO 45 SEMBAYAT MANYAR 61111 3943500 DR. ASLUCHUL ALIF PER/15/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

38 0900000000039 RS PETRO KIMIA GRESIK JL JEND A YANI 69 3976688 DR.SINGGIH PRIYANTO, MARS PER/02/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

39 1500000001993 RS SURYA MEDIKA GRESIK LABAN KULON 58 MENGANTI 61174 7914025 RS RAMLI TARIGAN PER/16/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

40 1500000001519 RS WATES HUSADA RAYA BALONG PANGGANG GRESIK DR TITIN PER/13/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

41 1400000000364 RS.MUHAMMADIYAH GRESIK JL.KH.KHOLIL NO.88 3981275 DR.MUSA GHUFRON PER/04/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

42 1400000000363 RSI DARUS SYIFA' BENOWO JL.RAYA BENOWO NO.5 BENOWO 7406293 DR.HM.FAIZ, SP.THT-KL PER/03/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

43 0900000000002 RSUD IBNU SINA GRESIK JL DR WAHIDIN SHD NO 243B 3951239 DR. ENDANG S, SP.THT PER/01/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

44 1500000000809 SURYA GIRI JAYA CERME JL. RAYA CERME GRESIK 63186435 YUNI HIDAYATI PER/10/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

KANTOR CABANG : N13- KANTOR CABANG SURABAYA DARMO


IKS


1 1500000001442 BP ASHABUL KAHFI JL MERBABU BLOK A NO.05 KEPUH PERMAI 8666334 CV KEMBANG TANJUNG PER/06/012016 RS.TRAUMA CENTRE

20/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


127 / 15116-05-201607:59:01



IKS


2 1500000001442 BP ASHABUL KAHFI JL MERBABU BLOK A NO.05 KEPUH PERMAI 8666334 CV KEMBANG TANJUNG PER/06/012016 RS.TRAUMA CENTRE 12/01/2016 31/12/2016

3 1500000001442 BP ASHABUL KAHFI JL MERBABU BLOK A NO.05 KEPUH PERMAI 8666334 CV KEMBANG TANJUNG PER/06/012016 RS.TRAUMA CENTRE 29/01/2016 31/12/2016

4 1500000001445 BP HIDAYAH WARU IV JL GRAHA TIRTA RAYA I NO.28 WARU 70350252 CV KEMBANG TANJUNG PER/07/012016 RS.TRAUMA CENTRE

01/02/2016 31/12/2016

5 1500000001445 BP HIDAYAH WARU IV JL GRAHA TIRTA RAYA I NO.28 WARU 70350252 CV KEMBANG TANJUNG PER/07/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

6 1500000001445 BP HIDAYAH WARU IV JL GRAHA TIRTA RAYA I NO.28 WARU 70350252 CV KEMBANG TANJUNG PER/07/012016 RS.TRAUMA CENTRE 20/01/2016 31/12/2016

7 1500000001444 BP KEBANGKITAN JL MANUKAN MADYA 141 SURABAYA 71258886 CV KEMBANG TANJUNG PER/08/012016RS.TRAUMA CENTRE 20/01/2016 31/12/2016

8 1500000001444 BP KEBANGKITAN JL MANUKAN MADYA 141 SURABAYA 71258886 CV KEMBANG TANJUNG PER/08/012016 RS.TRAUMA CENTRE

01/02/2016 31/12/2016

9 1500000001444 BP KEBANGKITAN JL MANUKAN MADYA 141 SURABAYA 71258886 CV KEMBANG TANJUNG PER/08/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

10 1500000001443 BP KESAYANGANJL RUNGKUT ASRI UTARA IV/10 (RL I/H-5) SURABAYA 8700691 CV KEMBANG TANJUNG PER/09/012016

RS.TRAUMA CENTRE 01/02/2016 31/12/2016

11 1500000001443 BP KESAYANGANJL RUNGKUT ASRI UTARA IV/10 (RL I/H-5) SURABAYA 8700691 CV KEMBANG TANJUNG PER/09/012016

RS.TRAUMA CENTRE 20/01/2016 31/12/2016

12 1500000001443 BP KESAYANGANJL RUNGKUT ASRI UTARA IV/10 (RL I/H-5) SURABAYA

8700691 CV KEMBANG TANJUNG PER/09/012016RS.TRAUMA CENTRE

12/01/2016 31/12/2016

13 1500000001446 BP KESEJAHTERAAN JL RUNGKUT MAPAN UTARA AA-17 SURABAYA

8706755 CV KEMBANG TANJUNG PER/10/012016 RS.TRAUMA CENTRE

20/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


128 / 15116-05-201607:59:01



IKS


14 1500000001446 BP KESEJAHTERAAN JL RUNGKUT MAPAN UTARA AA-17 SURABAYA 8706755 CV KEMBANG TANJUNG PER/10/012016 RS.TRAUMA

CENTRE 12/01/2016 31/12/2016

15 1500000001446 BP KESEJAHTERAAN JL RUNGKUT MAPAN UTARA AA-17 SURABAYA 8706755 CV KEMBANG TANJUNG PER/10/012016 RS.TRAUMA

CENTRE 01/02/2016 31/12/2016

16 1500000001335 KLINIK CITRA MEDICAL CENTRE

JL KETINTANG BARU III/56 SURABAYA 8291214 DR SAID MOHAMMAD T PER/15/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

17 1500000001393 KLINIK KARYA MEDIKA 104 JL BANYU URIP NO 302 SURABAYA 5324326 CV KARYA MEDIKA PER/16/012016 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

18 1500000001393 KLINIK KARYA MEDIKA 104 JL BANYU URIP NO 302 SURABAYA 5324326 CV KARYA MEDIKA PER/16/012016 RS.TRAUMA CENTRE 12/01/2016 31/12/2016

19 1500000001393 KLINIK KARYA MEDIKA 104 JL BANYU URIP NO 302 SURABAYA 5324326 CV KARYA MEDIKA PER/16/012016RS.TRAUMA CENTRE 01/02/2016 31/12/2016

20 1500000001394 KLINIK KARYA MEDIKA 111 BUKIT CITRA DARMO BLOK BC C30/JL KLAKAH REJO I-20 SURABAYA

CV KARYA MEDIKA PER/17/012016 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

21 1500000001394 KLINIK KARYA MEDIKA 111 BUKIT CITRA DARMO BLOK BC C30/JL KLAKAH REJO I-20 SURABAYA

CV KARYA MEDIKA PER/17/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

22 1500000001394 KLINIK KARYA MEDIKA 111BUKIT CITRA DARMO BLOK BC C30/JL KLAKAH REJO I-20 SURABAYA CV KARYA MEDIKA PER/17/012016

RS.TRAUMA CENTRE 01/02/2016 31/12/2016

23 1500000001395 KLINIK KARYA MEDIKA 41 JL NGAGLIK NO 47 SURABAYA 3764782 CV KARYA MEDIKA PER/18/012016RS.TRAUMA CENTRE 12/01/2016 31/12/2016

24 1500000001395 KLINIK KARYA MEDIKA 41 JL NGAGLIK NO 47 SURABAYA 3764782 CV KARYA MEDIKA PER/18/012016RS.TRAUMA CENTRE

20/01/2016 31/12/2016

25 1500000001395 KLINIK KARYA MEDIKA 41 JL NGAGLIK NO 47 SURABAYA 3764782 CV KARYA MEDIKA PER/18/012016 RS.TRAUMA CENTRE

01/02/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


129 / 15116-05-201607:59:01



IKS


26 1500000001379 KLINIK SARTIKA 36 BRATANG BINANGUN GANG VI/47 SURABAYA 34417343 DR LILIK SRI HARTINI PER/11/012016 RS.TRAUMA

CENTRE 12/01/2016 31/12/2016

27 1500000001379 KLINIK SARTIKA 36 BRATANG BINANGUN GANG VI/47 SURABAYA 34417343 DR LILIK SRI HARTINI PER/11/012016 RS.TRAUMA

CENTRE 20/01/2016 31/12/2016

28 1500000001379 KLINIK SARTIKA 36 BRATANG BINANGUN GANG VI/47 SURABAYA

34417343 DR LILIK SRI HARTINI PER/11/012016 RS.TRAUMA CENTRE

01/02/2016 31/12/2016

29 1500000001377 KLINIK SARTIKA 44 JL RAYA MASTRIP NO 32 KARANG PILANG SURABAYA

34200705 DR LILIK SRI HARTINI PER/12/012016 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

30 1500000001377 KLINIK SARTIKA 44 JL RAYA MASTRIP NO 32 KARANG PILANG SURABAYA 34200705 DR LILIK SRI HARTINI PER/12/012016 RS.TRAUMA

CENTRE 01/02/2016 31/12/2016

31 1500000001377 KLINIK SARTIKA 44JL RAYA MASTRIP NO 32 KARANG PILANG SURABAYA 34200705 DR LILIK SRI HARTINI PER/12/012016

RS.TRAUMA CENTRE 12/01/2016 31/12/2016

32 1500000001376 KLINIK SARTIKA 59 JL MANUKAN TENGAH 9K/10 SURABAYA 34183507 DR LILIK SRI HARTINI PER/13/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

33 1500000001317 KLINIK SARTIKA 77 JL TRUNOJOYO NO 2 SEPANJANG 7871549 DR LILIK SRI HARTINI PER/14/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

34 1500000001373 POLIKLINIK PUTRI RAHAYUJL MASTRIP IX/9 WARUGUNUNG KARANGPILANG 7667983 BILAL ZAENAL ABIDIN PER/05/012016

RS.TRAUMA CENTRE 20/01/2016 31/12/2016

35 1500000001373 POLIKLINIK PUTRI RAHAYUJL MASTRIP IX/9 WARUGUNUNG KARANGPILANG 7667983 BILAL ZAENAL ABIDIN PER/05/012016

RS.TRAUMA CENTRE 29/01/2016 31/12/2016

36 1500000001373 POLIKLINIK PUTRI RAHAYUJL MASTRIP IX/9 WARUGUNUNG KARANGPILANG

7667983 BILAL ZAENAL ABIDIN PER/05/012016RS.TRAUMA CENTRE

12/01/2016 31/12/2016

37 1100000000018 RS BHAKTI RAHAYU (TC) JL KETINTANG MADYA I / 6 SURABAYA 8289668 PT BHAKTI RAHAYU PER/03/012016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


130 / 15116-05-201607:59:01



IKS


38 1100000000008 RS BUNDA SURABAYA JL RAYA KANDANGAN 23-24 7440077 PT PERMATA BUNDA BERSAMA PER/02/012015 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

39 0900000000003 RS MUJI RAHAYU JL RY MANUKAN WETAN 68-68A SURABAYA 7404132 YAYASAN MUJI RAHAYU PER/01/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

40 1400000000385 RS WIYUNG SEJAHTERA JL KARANGAN PDAM NO 1-3 WIYUNG SURABAYA

7532653 PT WIYUNG SEJAHTERA PER/04/012016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016

KANTOR CABANG : N14- KANTOR CABANG SURABAYA TANJUNG PERAK


IKS


1 1400000000517 KLINIK WISMA HUSADA JL DUKUH SETRO 7A KAV NO 2 PER/ 01/ 01-2016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

2 1400000000517 KLINIK WISMA HUSADA JL DUKUH SETRO 7A KAV NO 2 PER/ 01/ 012016 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

3 0700000000012 RS AL-IRSYAD JL KHM MANSUR 210-214 SURABAYA 3531223DR AHMAD BAKARMAN, MARS PER/ 02/012016

RS.TRAUMA CENTRE 13/01/2016 31/10/2016

4 0700000000012 RS AL-IRSYAD JL KHM MANSUR 210-214 SURABAYA 3531223DR AHMAD BAKARMAN, MARS PER/ 02/012016

RS.TRAUMA CENTRE 20/01/2016 31/12/2016

5 1400000000469RUMAH SAKIT PRIMASATYAHUSADA CITRA

JL. PRAPAT KURUNG SELATAN NO. 1 3294801PT RUMAH SAKIT PRIMASATYA HUSADA CITRA

PER/ 03/ 012016RS.TRAUMA CENTRE

20/01/2016 31/12/2016

KANTOR CABANG : N15- KANTOR CABANG SURABAYA RUNGKUT


Periode : 01/01/2016 s/d 31/12/2016


131 / 15116-05-201607:59:01



IKS


1 7-3127077493 RS ANGKATAN LAUT DR. RAMELAN SURABAYA JL. GADUNG NO. 1 SURABAYA 60238 RSAL DR RAMELAN

SURABAYA PER/01/042016 RS.TRAUMA CENTRE 01/05/2016 31/12/2017

2 1100000000022 RS ISLAM SURABAYA JEMURSARI JL JEMURSARI 51-57 60236 847187778 YAYASAN RS ISLAM

SURABAYA PER/01/082015 RS.TRAUMA CENTRE 08/01/2016 31/12/2016

KANTOR CABANG : P00- KANTOR CABANG PONTIANAK


IKS


1 1400000000243RS BHAYANGKARA PONTIANAK JL. KS TUBUN NO. 14 78111

0561736610 DRG. SUGIYATO PER/12/032016

RS.TRAUMA CENTRE 04/03/2016 28/02/2017

2 1400000000373 RS SANTO VINCENTIUS SINGKAWANG

JL P DIPONEGORO NO. 5 79123 636768 DR. HUSIN BASIR MSC. M.KES


11/04/2016 31/03/2017

3 1400000000383 RSUD KABUPATEN SANGGAU

JL JENDRAL SUDIRMAN 78511 21070 DR. H. EDY SUPRABOWO,MKM


24/02/2016 31/12/2016

4 7-2891931853 RUMAH SAKIT FATIMA JL. JENDRAL SUDIRMAN NO 27 78811 00032814DR. MARGARETHA INDAH W., MPH PER/16/042016

RS.TRAUMA CENTRE 12/04/2016 31/03/2017

5 1400000000464RUMAH SAKIT UMUM BETHESDA SERUKAM

JL. RAYA SINGKAWANG-BENGKAYANG KM48 79281 637019

DR. EDY ARISTON LUBIS,SPM., M.SC PER/11/022016

RS.TRAUMA CENTRE 24/02/2016 31/01/2017

6 7-2877295653RUMAH SAKIT UMUM PARINDU

DUSUN DOHIK EMPANING DESA BINJAI 78562DR. HENDRA HADIYANTA


11/04/2016 31/03/2017

KANTOR CABANG : R00- KANTOR CABANG BANJARMASIN


Periode : 01/01/2016 s/d 31/12/2016


132 / 15116-05-201607:59:01



IKS


1 7-2797750137 RSJ SAMBANG LIHUM BANJARMASIN

JL. GUBENRNUR SYARKAWI KM 3,9 GAMBUT KAB. BANJAR 00000 H.IBG DHARMA PUTRA PER/03/032016 RS.TRAUMA

CENTRE 11/04/2016 17/03/2017

2 7-2464169583 RSUD ULIN BANJARMASIN JL. A. YANI NO.43 BANJARMASIN 70233 33257472 DR. HJ. SUCIATI M. KES PER/02/032016 RS.TRAUMA CENTRE 10/03/2016 02/03/2017

KANTOR CABANG : R02- KANTOR CABANG KOTABARU


IKS


1 1500000000845RUMAH SAKIT UMUM DAERAH KOTABARU JL.H.HASAN BASRI NO.57 22945 PER/01/012016

RS.TRAUMA CENTRE 01/01/2016 31/12/2016

KANTOR CABANG : R03- KANTOR CABANG PALANGKARAYA


IKS


1 7-2907310053 RSUD DR DORIS SYLVANUS JL TAMBUN BUNGAI NO 04 73111 PEMERINTAH DAERAH PER / 11 /022016RS.TRAUMA CENTRE 13/04/2016 26/02/2017

2 1300000000039RSUD DR SOEMARNO SOSROADMODJO

JL TAMBUN BUNGAI NO 16 KAPUAS 23791 PEMKAB KAPUAS PER/13/062015RS.TRAUMA CENTRE

02/03/2016 04/06/2017

3 1300000000046 RUMAH SAKIT BHAYANGKARA TK IV

JL JENDERAL A YANI NO 22 3281553 POLDA KAL TENG PER/13/032016 RS.TRAUMA CENTRE

13/04/2016 28/02/2017

4 7-2201647033UPT PUSKESMAS TANGKILING PALANGKARAYA

JL TJILIK RIWUT KM 34 KEL TANGKILING KEC BUKIT BATU

73221 UPT PUSKESMAS TANGKILING


24/02/2016 22/07/2016


Periode : 01/01/2016 s/d 31/12/2016


133 / 15116-05-201607:59:01


KANTOR CABANG : R04- KANTOR CABANG PANGKALAN BUN


IKS


1 7-1706946523 PUSKESMAS KUMAI JL PEMUDA KECAMATAN KUMAI 74181 DR ABIMAYU PER/03/012016 RS.TRAUMA CENTRE

29/01/2016 18/01/2017

2 7-1702557673 PUSKESMAS SEMANGGANG JL A YANI KM 60 SEMANGGANG KEC PANGKALAN BANTENG 74183 DR JHONFERI

SIDABALOK PER/02/012016 RS.TRAUMA CENTRE 29/01/2016 18/01/2017

KANTOR CABANG : S00- KANTOR CABANG BALIKPAPAN


IKS


1 1500000000552 POLIKLINIK IBNU SINA BALIKPAPAN JL.JEND.A.YANI NO.252 KEL.MUARA RAPAK 7091900 DR.HADI YUNIARKO PER/16/042016 RS.TRAUMA

CENTRE 26/04/2016 31/03/2017

2 1400000000064 RS BALIKPAPAN BARUJL MT HARYONO KOMPLEK BALIKPAPAN BARU BLOK A3 A NO 7-9 KALTIM 877330 DR M DANARTO, M MED PER/09/04/2016

RS.TRAUMA CENTRE 26/04/2016 28/02/2017

3 7-3289201063RSUD DR.KANUJOSO DJATIWIBOWO BALIKPAPAN

JL.MT.HARYONO NO.656, BALIKPAPAN 76125DR.EDY ISKANDAR,SP.PD.,FINASIM.,MARS


13/05/2016 01/05/2017

4 1500000000729 RSUD KOTA BALIKPAPAN JL.MAYJEND SUTOYO RT.01 KEL.GUNUNG SARI ULU KEC.BALIKPAPAN TENGAH

DRG.DYAH MURYANI PER/13/042016 RS.TRAUMA CENTRE

11/05/2016 31/03/2017

5 1500000000184 RSUD PENAJAM PASER UTARA

JL.PROPINSI KM.09 PENAJAM PASER UTARAKALTIM

7211361 DR.JANSJE GRACE MAKISURAT


11/05/2016 05/02/2017

6 1500000000188RUMAH SAKIT BHAYANGKARA BALIKPAPAN

JL.JEND.SUDIRMAN NO.14 BALIKPAPAN 421261DR.WILDAN DJAYA SOEKMARA,SP.B,FINACS PER/12/042016

RS.TRAUMA CENTRE 11/05/2016 28/02/2017


Periode : 01/01/2016 s/d 31/12/2016


134 / 15116-05-201607:59:01


KANTOR CABANG : S01- KANTOR CABANG SAMARINDA


IKS


1 7-1380214421 PUKESMAS BANTUAS JL BANTUAS PALARAN 75241 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

2 7-1464240699 PUSKESMAS AIR PUTIH JL AIR PUTIH SAMARINDA ULU 75122 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE 24/02/2016 31/12/2016

3 7-1464311570 PUSKESMAS BAQA JL BAQA SAMARINDA SEBERANG 75131 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE 20/01/2016 31/12/2016

4 7-1356917662 PUSKESMAS BENGKURING BENGKURING 75118 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE 11/01/2016 31/12/2016

5 7-1380408843 PUSKESMAS BUKUAN JL BUKUAN PALARAN 75241 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

6 7-1464600433 PUSKESMAS HARAPAN BARU

JL HARAPAN BARU SAMARINDA SEBERANG 75131 PEMERINTAH PKS/02/12.2015 RS.TRAUMA

CENTRE 20/01/2016 31/12/2016

7 7-1359826423 PUSKESMAS JUANDA JL IR JUANDA SAMARINDA ULU 75122 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE 11/01/2016 31/12/2016

8 7-1507208803PUSKESMAS KARANG ASAMSAMARINDA

JL KARANG ASAM 75125 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE

20/01/2016 31/12/2016

9 7-1464440551 PUSKESMAS LEMPAKE JL LEMPAKE SAMARINDA UTARA 75118 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

10 7-1466746238 PUSKESMAS LOA BAKUNG JL LOA BAKUNG SUNGAI KUNJANG 75125 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

11 7-1380502014 PUSKESMAS MAKROMAN JL MAKROMAN PALARAN 75241 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE 12/01/2016 31/12/2016

12 7-1464657234PUSKESMAS MANGKUPALAS JL MANGKUPALAS SAMARINDA SEBERANG 75131 PEMERINTAH PKS/02/12.2015

RS.TRAUMA CENTRE 20/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


135 / 15116-05-201607:59:01



IKS


13 7-1464111057 PUSKESMAS PALARAN JL PALARAN 75241 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE 20/01/2016 31/12/2016

14 7-1380304232 PUSKESMAS PASUNDAN JL PASUNDAN KEL JAWA SAMARINDA ULU 75122 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE 12/01/2016 31/12/2016

15 7-1463967676 PUSKESMAS REMAJA JL REMAJA SUNGAI PINANG 75117 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

16 7-1464167298 PUSKESMAS SAMBUTAN JL SAMBUTAN 75114 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

17 7-1461318105 PUSKESMAS SEGIRI JL SEGIRI SAMARINDA KOT 75111 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE 20/01/2016 31/12/2016

18 7-1380543865 PUSKESMAS SEMPAJA SEMPAJA SAMARINDA UTARA 75118 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE 12/01/2016 31/12/2016

19 7-1465607297 PUSKESMAS SIDOMULYO JL SIDOMULYO SAMARINDA ILIR 75114 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

20 7-1464546252 PUSKESMAS SUNGAI KAPIH JL SUNGAI KAPIH SAMBUTAN 75114 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

21 7-1378835889 PUSKESMAS SUNGAI SIRING KELURAHAN SUNGAI SIRING SAMARINDA 75118 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE 12/01/2016 31/12/2016

22 7-1380635626 PUSKESMAS TEMINDUNG JL TEMINDUNG SAMARINDA UTARA 75118 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE 12/01/2016 31/12/2016

23 1500000000941PUSKESMAS TRAUMA CENTRE

JL CIPTO MANGUNKUSUMO KEL SENGKOTEK KEC LOA JANAN ILIR

PKS/02/12.2015RS.TRAUMA CENTRE

11/04/2016 31/12/2016

24 7-1380777307 PUSKESMAS WONOREJO KELURAHAN WONOREJO 75125 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

12/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


136 / 15116-05-201607:59:01



IKS


25 1400000000160 RS. ISLAM SAMARINDA JL. GURAMI NO.18 741510 DR. SYAFARDI IBRAHIM PKS/01/052015 RS.TRAUMA CENTRE 11/04/2016 30/04/2016

26 7-3057671463 RSJD ATMA HUSADA MAHAKAM JL KAKAP NO 23 KOTA SAMARINDA 75114 PEMERINTAH PKS/01/042016 RS.TRAUMA

CENTRE 25/04/2016 31/03/2017

27 1500000000320 RSUD ABDUL WAHAB SJAHRANI

JL PMI KOTA SAMARINDA PKS/01/032016 RS.TRAUMA CENTRE

18/03/2016 31/12/2016

28 1400000000413 RSUD HARAPAN INSAN SENDAWAR

JL MAWAR KEC. SEKOLAQ DARAT 4044001 PKS/01/112015 RS.TRAUMA CENTRE

11/04/2016 31/10/2016

29 7-1356184197 RSUD I.A MOEIS JL H.A M.M RIFADDIN 75131 PEMERINTAH PKS/01/12.2015 RS.TRAUMA CENTRE 11/01/2016 31/12/2016

KANTOR CABANG : S02- KANTOR CABANG TARAKAN


IKS


1 1300000000043BLUD RSD. DR. SOEMARNO SOSROADMODJO BULUNGAN

JL. CENDRAWASIH TANJUNG SELOR 21292 PEMKAB BULUNGAN PER/03/022016RS.TRAUMA CENTRE 10/03/2016 31/01/2017

KANTOR CABANG : S04- KANTOR CABANG BERAU


IKS


1 7-1506142935 PUSKESMAS GUNUNG TABUR

JL. BANGSAWAN RT 02 GUNUNG TABUR KAB. BERAU

77352 DINAS KESEHATAN KABUPATEN BERAU


20/01/2016 01/12/2016


Periode : 01/01/2016 s/d 31/12/2016


137 / 15116-05-201607:59:01



IKS


2 7-1507943081 PUSKESMAS KAMPUNG BUGIS

JL. H. ISA I KEL. GAYAM KEC. TANJUNG REDEB KAB. BERAU 77311 DINAS KESEHATAN

KABUPATEN BERAU PER/06/122015 RS.TRAUMA CENTRE 20/01/2016 01/12/2016

3 7-1506142939 PUSKESMAS SAMBALIUNG MANGKUBUMI II RT 007 SAMBALIUNG, KAB. BERAU 77371 DINAS KESEHATAN

KABUPATEN BERAU PER/06/122015 RS.TRAUMA CENTRE 20/01/2016 01/12/2016

4 7-1506142933 PUSKESMAS TELUK BAYUR JL. KANDANG MUNTIK, KEL. TELUK BAYURKAB. BERAU

77315 DINAS KESEHATAN KABUPATEN BERAU


20/01/2016 01/12/2016

KANTOR CABANG : T00- KANTOR CABANG MANADO


IKS


1 1400000000069 DR. FRANS PALILIEWU JLN. SUTOYO NO. 106 KOTAMOBAGU 21192 DR. FRANS PALILIEWU PER/011/032016 RS.TRAUMA CENTRE

31/03/2016 31/12/2017

2 1400000000070 PRAKTEK DR RAUW GEERTJE ADELEIDA

JL TNI 4 NO 53 TIKALA ARES LINGK II MANADO

3357822 DR RAUW G ADELEIDA PER/008/032016 RS.TRAUMA CENTRE

01/03/2016 31/12/2017

3 02412 RS BUDI MULIA BITUNG JL YOS SUDARSO BITUNG 21332DR. JOHANNIS ANDRIES NAJOAN MKES. SPFK.DK PER/22/10/2015

RS.TRAUMA CENTRE 28/01/2016 31/12/2017

4 1400000000066 RS KINAPITJLN. JENDRAL S PARMAN NO. 201 KOTAMOBAGU 21192 DR. FRANS PALILIEWU PER/010/032016

RS.TRAUMA CENTRE 31/03/2016 31/12/2017

5 1400000000068RS ROBERT WOLTER MONGISIDI

JLN. 14 FEBRUARI TELING ATAS 876087 DR. ADHY SUGIH ARTO PER/007/03/2016RS.TRAUMA CENTRE

01/03/2016 31/12/2017

6 1400000000067 RS SITTI MARYAM JLN. POGIDON RAYA NO. 110 KEC. TUMINTING

851577 DR. ANY RACHMAN PER/005/032016 RS.TRAUMA CENTRE

01/03/2016 31/12/2017


Periode : 01/01/2016 s/d 31/12/2016


138 / 15116-05-201607:59:01



IKS


7 1400000000078 RSU PANCARAN KASIH GMIM MANADO JL SAM RATULANGI XIII MANADO 857629 DR FRANKY V T

KAMBEY PER/004/032016 RS.TRAUMA CENTRE 01/03/2016 31/12/2017

8 7-2330823833 RSUP PROF DR R D KANDOU JL RAYA TANAWANGKO NO 56 95115DR. MAXI R. RONDONUWU, DHSM, MARS


9 1500000000352 RUMAH SAKIT BHAYANGKARA MANADO

JALAN SAM RATULANGI NO. 326 MANADO DRG. IGNATIUS HENDRA ARIFIANTO


01/03/2016 31/12/2017

10 1500000000085 RUMAH SAKIT BUDI MULIA BITUNG

JL. SAM RATULANGI X/9A BITUNG LUCI PER/022/10/2015 RS.TRAUMA CENTRE

28/01/2016 31/12/2017

11 1400000000232 RUMAH SAKIT UMUM BETHESDA JALAN RAYA TOMOHON, KOTA TOMOHON 891020 DR ROBBIN R.F WAROUW PER/003/072016 RS.TRAUMA

CENTRE 01/03/2016 31/12/2017

12 1400000000153RUMAH SAKIT UMUM HERMANA LEMBEAN

JLN. A. MONONUTU DESA LEMBEAN, MINAHASA UTARA 891020

DR. LAURENTIUS RONALD PONTOH PER/006/032016

RS.TRAUMA CENTRE 01/03/2016 31/12/2017

13 1400000000059 RUMKITAL DR. WAHYU SLAMET

JALAN YOS SUDARSO NO. 26 BITUNG 35030 DR. SUJOKO PURNOMO, SP.B


01/03/2016 31/12/2017

14 1400000000428 SILOAM INTERNATIONAL HOSPITAL MANADO

JLN. SILOAM NO. 6 LIPPO VILLAGE TANGERANG

DR. ANDRY, M.M M.H.KES


28/01/2016 31/12/2017

KANTOR CABANG : T01- KANTOR CABANG PALU


IKS


1 1500000000952 POLIKLINIK PT. HARDAYA INTI PLANTATIONS

PT. HARDAYA INTI PLANTATIONS 3149088 IR. YANI ANSHORI PER/005/022016 RS.TRAUMA CENTRE

01/05/2016 30/04/2018


Periode : 01/01/2016 s/d 31/12/2016


139 / 15116-05-201607:59:01



IKS


2 1400000000290 PUSKESMAS SALAKAN SALAKAN KABUPATEN BANGGAI KEPULAUAN

DR. JAMES HD PINONTOAN PER/16/082015 RS.TRAUMA

CENTRE 14/01/2016 31/07/2016

3 7-2728692225 RS. BUDI AGUNG JL. MALUKU NO. 44 KOTA PALU 94231 0451-421360

DR. IDA BAGUS YADNYAPUTRA PER/013/032016 RS.TRAUMA

CENTRE 01/04/2016 31/05/2018

4 1400000000054 RSD. MADANI JL.THALUA KONCHI NO.11 MAMBORO 94111 491470 DR. ISHARWATI M.KES PER/002/012016 RS.TRAUMA CENTRE

01/03/2016 28/02/2017

5 1400000000081 RSU LUWUK JL. IMAM BONJOL NO. 14 LUWUK 21820 DR. YUSRAN KASIM ME PER/003/012016 RS.TRAUMA CENTRE

27/04/2016 31/03/2018

6 1400000000083 RSU. ANUTAPURA JL. KANGKUNG NO. 01 PALU 94111 462770 DR. FARIDA H. INGOLO, M.KES PER/001/012016 RS.TRAUMA

CENTRE 18/03/2016 28/02/2018

7 1400000000231 RSUD KABELOTA JL. TRANS SULAWESI KAB. DONGGALA DRG. AMRIANI LAPASE PER/010/032016RS.TRAUMA CENTRE 01/06/2016 31/05/2018

8 1500000000735 RSUD TORA BELO JL. POROS PALU-PALOLO DESA SIDERA 94364 DRG. HARI SETIYONO PER/007/022016 RS.TRAUMA CENTRE

01/05/2016 30/04/2018

KANTOR CABANG : T02- KANTOR CABANG GORONTALO


IKS


1 1400000000156KWANDANG MEDICAL CENTER

JL TRANS SULAWESI DESA MOLUO KEC KWANDANG


09/05/2016 17/04/2018

2 1500000000879 PUSKESAMAS ASPARAGA DESA BULULI KEC ASPARAGA KAB GORONTALO

DINAS KESEHATAN KABUPATEN GORONTALO


01/05/2016 31/03/2018


Periode : 01/01/2016 s/d 31/12/2016


140 / 15116-05-201607:59:01



IKS


3 1500000000908 PUSKESMAS BATUDAA DESA PANYUNGA KEC BATUDAADINAS KESEHATAN KABUPATEN GORONTALO


4 1500000000886 PUSKESMAS BATUDAA PANTAI

JL TRANS SULAWESI KM 38 DESA KAYUBULAN KEC BATUDAA PANTAI KAB GORONTALO



5 1500000000877 PUSKESMAS BILATO DESA BILATO KEC BOLIYOHUTO KAB GORONTALO



01/05/2016 31/03/2018

6 1500000000906 PUSKESMAS BILUHU DESA LOBUTO KEC BILUHU KAB GORONTALO



01/05/2016 31/03/2018

7 1500000000883 PUSKESMAS BOLIYOHUTO DESA SIDOMULYO KEC BOLIYOHUTO KAB GORONTALO



8 1500000000880 PUSKESMAS BUHUDESA BUHU KEC TIBAWA KAB GORONTALO



9 1500000000884 PUSKESMAS DUNGALIYO DESA KALIYOSO KEC BONGOMEME KAB GORONTALO

DINAS KESEHATAN KAB GORONTALO


01/05/2016 31/03/2018

10 1500000000864 PUSKESMAS LIMBOTO JL TILONGKABILA KEL HEPUHULAWA KEC LIMBOTO

96211DINAS KESEHATAN KABUPATEN GORONTALO


01/05/2016 31/03/2018

11 1500000000870PUSKESMAS LIMBOTO BARAT

JL TRANS SULAWESI DESA YOSONEGORO KEC LIMBOTO BARAT



12 1500000000881 PUSKESMAS MOLOPATODUDESA MOLOPATODU KEC BONGOMEME KAB GORONTALO



13 1500000000875 PUSKESMAS MOOTILANGODESA PARIS KEC MOOTILANGO KAB GORONTALO



01/05/2016 31/03/2018

14 1500000000876 PUSKESMAS PILOHAYANGA DESA DULOHUPA KEC TELAGA KAB GORONTALO



01/05/2016 31/03/2018


Periode : 01/01/2016 s/d 31/12/2016


141 / 15116-05-201607:59:01



IKS


15 1500000000878 PUSKESMAS PULUBALA DESA PONGONGAILA KEC PULUBALA KAB GORONTALO



16 1500000000885 PUSKESMAS TABONGO DESA TABONGO BARAT KEC TABONGO KAB GORONTALO



17 1500000000910 PUSKESMAS TELAGA JALAN LIMBOTO RAYA DESA MONGOLATOKEC TELAGA



01/05/2016 31/03/2018

18 1500000000905 PUSKESMAS TELAGA BIRU JL LIMBOTO RAYA DESA TULADENGGI KECTELAGA BIRU



01/05/2016 31/03/2018

19 1500000000907 PUSKESMAS TELAGA JAYA DESA HUTADAA KEC TELAGA JAYA KAB GORONTALO



20 1500000000904 PUSKESMAS TIBAWADESA ISIMU SELATAN KEC TIBAWA KAB GORONTALO



21 1500000000909 PUSKESMAS TILANGO DESA TILOTE KEC TILANGO KAB GORONTALO



01/05/2016 31/03/2018

22 1500000000874 PUSKESMAS TOLANGOHULA

DESA SUKA MAKMUR KEC TOLANGOHULAKAB GORONTALO



01/05/2016 31/03/2018

23 1400000000104 RSUD M.M.DUNDAJLN ACHMAD A. WAHAB NO 53 KEC LIMBOTO 881455 RSUD DR M.M DUNDA PER/01/012016

RS.TRAUMA CENTRE 10/02/2016 31/12/2017

24 1400000000477 RSUD OTANAHAJL RAMBUTAN NO 413 KEL BULADU KEC KOTA BARAT RSUD OTANAHA PER/02/012016

RS.TRAUMA CENTRE 01/03/2016 31/12/2017

25 1400000000102RSUD PROF DR. H. ALOEI SABOE

JL PROF DR H ALOEI SABOE KEL WONGKADITI TIMUR

RSUD PROF DR. H. ALOEI SABOE


10/02/2016 31/12/2016

26 1400000000155 RSUD TOTO KABILA JL KESEHATAN NO 25 DESA PERMATA KEC TILONGKABILA

8701943 RSUD TOTO KABILA PER/05/012016 RS.TRAUMA CENTRE

10/02/2016 31/12/2017


Periode : 01/01/2016 s/d 31/12/2016


142 / 15116-05-201607:59:01



IKS


27 1400000000157 RSUD ZAINAL UMAR SIDIKI DESA BULALO KEC KWANDANG KAB GORUT 96252 RSUD ZAINAL UMAR

SIDIKI PER/10/042016 RS.TRAUMA CENTRE 20/04/2016 31/03/2018

28 1500000001830 RUMAH SAKIT ISLAM GORONTALO

JL PROF DR HB JASSIN NO 457 KOTA GORONTALO 96128 830820

YAYASAN KESEJAHTERAAN UMAT HASANAH GORONTALO


29 1400000000472 RUMAH SAKIT UMUM BUNDA

JL PROF DR HB JASSIN KEL WUMIALO KEC KOTA TENGAH

829290 DANIEL RANTI PER/03/012016 RS.TRAUMA CENTRE

04/04/2016 03/01/2018

KANTOR CABANG : W00- KANTOR CABANG MAKASSAR


IKS


1 1500000000032 BALAI LATIHAN KERJA INDUSTRI MAKASSAR

JL.TAMAN MAKAM PAHLAWAN NO 4 PER/012/012016 RS.TRAUMA CENTRE

16/03/2016 07/01/2018

2 1500000000032 BALAI LATIHAN KERJA INDUSTRI MAKASSAR

JL.TAMAN MAKAM PAHLAWAN NO 4 PER/012/012016 RS.TRAUMA CENTRE

14/03/2016 07/01/2018

3 1500000000027BALAI LATIHAN KERJA KOTAMADYA PARE PARE JL BAU MASSEPE, PARE-PARE 23046 PER/019/012016

RS.TRAUMA CENTRE 14/03/2016 04/01/2018

4 1500000000027BALAI LATIHAN KERJA KOTAMADYA PARE PARE JL BAU MASSEPE, PARE-PARE 23046 PER/019/012016

RS.TRAUMA CENTRE 16/03/2016 04/01/2018

5 1400000000117HEALTH AND NUTRITION CLINIC

JL PERINTIS KEMERDEKAAN KM 8 KOMP RUKO ANTARA NO 25

581983PROF.DR.DR.HJ.SURYANI AS'AD M,SC,SP.GK


14/03/2016 04/01/2018

6 1400000000117 HEALTH AND NUTRITION CLINIC

JL PERINTIS KEMERDEKAAN KM 8 KOMP RUKO ANTARA NO 25

581983 PROF.DR.DR.HJ.SURYANI AS'AD M,SC,SP.GK


16/03/2016 04/01/2018


Periode : 01/01/2016 s/d 31/12/2016


143 / 15116-05-201607:59:01



IKS


7 7-2377521926 KLINIK IMEDICAL SPECIALIST CENTRE JL. RACING CENTRE NO 17/39 MAKASSAR 90231 DR.DR.MASYITA

GAFFAR, SP.THT-KL PER/001/012016 RS.TRAUMA CENTRE 07/03/2016 04/01/2018

8 1400000000075 KLINIK SEROJA JL. GOA RIA NO. 106 SUDIANG 550228 DR. MOH. HELMY JUSUF PER/008/012016 RS.TRAUMA CENTRE 14/03/2016 04/01/2018

9 1400000000075 KLINIK SEROJA JL. GOA RIA NO. 106 SUDIANG 550228 DR. MOH. HELMY JUSUF PER/008/012016 RS.TRAUMA CENTRE

16/03/2016 04/01/2018

10 1400000000161 PUSKESMAS BUNGORO KECAMATAN BUNGORO KAB PANGKEP 4291557 DRG ANWAR NUHUNG PER/016/012016 RS.TRAUMA CENTRE

14/03/2016 04/01/2018

11 1400000000161 PUSKESMAS BUNGORO KECAMATAN BUNGORO KAB PANGKEP 4291557 DRG ANWAR NUHUNG PER/016/012016 RS.TRAUMA CENTRE 16/03/2016 04/01/2018

12 1400000000170RS AKADEMIS JAURY JUSUF PUTERA JL JEND M JUSUF NO 57 A MAKASSAR 317343 PER/011/012016

RS.TRAUMA CENTRE 14/03/2016 04/01/2018

13 1400000000044 RS AWAL BROS MAKASSAR JL. JENDRAL URIP SUMOHARJO NO. 43 454567 PT MAKASSAR GLOBAL AWAL BROS


24/02/2016 31/12/2017

14 1500000000108 RS DR M YASIN BONE JL JENDRAL SUDIRMAN WATAMPONE BONE


14/03/2016 04/01/2018

15 1400000000046RS ISLAM FAISAL MAKASSAR

JALAN ANDI PANGERAN PETTARANI MAKASSAR 871942

PROF DR H SYAFRUDDIN WAHID PHD,SP,PA(K) PER/004/012016

RS.TRAUMA CENTRE 07/03/2016 04/01/2018

16 1500000000333 RSU HIKMAH JL YOSEF LATUMAHINA NO 1 872284 PER/014/012016RS.TRAUMA CENTRE 14/03/2016 04/01/2018

17 1500000000028 RSU LASINRANG PINRANG JL MACAN NO 9 KABUPATEN PINRANG 921118 PER/020/012016RS.TRAUMA CENTRE

14/03/2016 04/01/2018

18 1400000000190 RSUD ANDI MAKASSAU JL NURUSSAMAWATI NO 9 PAREPARE 21163 II.DR. H. KAMARUDDIN SAID, SP.B, MARS


18/03/2016 04/05/2017


Periode : 01/01/2016 s/d 31/12/2016


144 / 15116-05-201607:59:01



IKS


19 1500000000299 RSUD BARRU PER/018/012016 RS.TRAUMA CENTRE 14/03/2016 04/01/2018

20 1400000000338 RSUD H. ANDI SULTHAN DAENG RADJA JL. SERIKAYA NO 17 BULUKUMBA 84637 PEMERINTAH KAB

BULUKUMBA PER/024/012016 RS.TRAUMA CENTRE 14/03/2016 04/01/2018

21 1500000000033 RSUD HAJI MAKASSAR JL DG MASEPPE PER/013/012016 RS.TRAUMA CENTRE

14/03/2016 04/01/2018

22 1400000000171 RSUD HAJI PADJONGA DAENG NGALLE

JL INCE HUSEIN DAENG PARANI NO 1 21065 PER/021/012016 RS.TRAUMA CENTRE

14/03/2016 04/01/2018

23 1500000000021 RSUD KONDOSAPATA' KAB. MAMASA

JALAN POROS BALAMBANG KEL. MINAKE KEC. TANDUKKALUA' KAB. MAMASA PER/005/012016 RS.TRAUMA

CENTRE 14/03/2016 04/01/2018

24 1400000000345RSUD LAMADUKELLENG SENGKANG WAJO JL KARTIKA CANDRA KIRANA SENGKANG PER/027/012016

RS.TRAUMA CENTRE 14/03/2016 04/01/2018

25 1400000000173 RSUD LANTO DAENG PASEWANG

JL LINGKAR KARISA BONTOSUNGGU NO 21004 PER/022/012016 RS.TRAUMA CENTRE

14/03/2016 04/01/2018

26 1400000000195 RSUD LATEMMAMALA JL MALAKA RAYA WATANSOPPENG PER/026/012016 RS.TRAUMA CENTRE

14/03/2016 04/01/2018

27 1500000000109 RSUD MAJENE JALAN POROS MAJENE MAMUJU PER/029/012016RS.TRAUMA CENTRE 14/03/2016 04/01/2018

28 1400000000462 RSUD MAMUJU JL KURUNGAN BASSI 21107 PER/028/012016RS.TRAUMA CENTRE 14/03/2016 04/01/2018

29 1400000000189 RSUD PANGKEP JL ST HASANUDDIN KABUPATEN PANGKEP 2311118 ARMAN PER/017/012016RS.TRAUMA CENTRE

14/03/2016 04/01/2018

30 1400000000339 RSUD PROF. DR. H. M. ANWAR MAKKATUTU

JL. TERATAI NO. 20 BANTAENG 23126 PEMERINTAH KAB. BANTAENG


14/03/2016 04/01/2018


Periode : 01/01/2016 s/d 31/12/2016


145 / 15116-05-201607:59:01



IKS


31 1400000000172 RSUD SALEWANGANG MAROS JL POROS MAROS MAKASSAR KM 3 371166 PER/015/012016 RS.TRAUMA

CENTRE 14/03/2016 04/01/2018

32 1400000000077 RSUD SAYANG RAKYAT MAKASSAR

JL. PAHLAWAN NO. 1000 KEL. BULUROKENG KEC. BIRINGKANAYA 5068931 PEMERINTAH PROVINSI

SULAWESI SELATAN PER/007/012016 RS.TRAUMA CENTRE 14/03/2016 04/01/2018

33 1500000000480 RSUD SYEKH YUSUF KABUPATEN GOWA

JL DR WAHIDIN SUDIRO HUSODO NO 48 SUNGGUMINASA


14/03/2016 15/01/2018

34 1500000000111 RSUP DR WAHIDIN SUDIROHUSODO MAKASSAR

JL PERINTIS KEMERDEKAAN KM 11 TAMALANREA


01/03/2016 04/01/2018

35 1400000000162 RUMAH SAKIT BHAYANGKARA MAKASSAR JL. LETJEND. POL. MAPPAOUDANG NO. 63 836344 KEPOLISIAN NEGARA

REPUBLIK INDONESIA PER/010/012016 RS.TRAUMA CENTRE 14/03/2016 04/01/2018

KANTOR CABANG : W01- KANTOR CABANG KENDARI


IKS


1 1400000000193BLUD RSU KONAWE SELATAN JL POROS ANDOLOO NO.1

PEMERINTAH KABUPATEN KONAWE SELATAN


2 1400000000293 RS SANTA ANNA KENDARI JL. DR. MOH HATTA NO 65 A 41916365PT CITRA RATNA NIRMALA PER/015/022016

RS.TRAUMA CENTRE 22/02/2016 31/01/2017

3 1400000000062 RSUD KOTA KENDARI JL BRIGJEN Z.A SUGIANTO NO.39DINAS KESEHATAN KOTA KENDARI


22/02/2016 04/02/2017

4 1400000000381 RSUD KAB KOLAKA (BLUD) JL.WR SUPRATMAN NO 20 32213700 DINAS KESEHATAN KOLAKA


25/02/2016 08/02/2018


Periode : 01/01/2016 s/d 31/12/2016


146 / 15116-05-201607:59:01



IKS


5 1400000000422 RSUD KAB KONAWE JL. DIPONEGORO NO 301 DINAS KESEHATAN KAB.KONAWE PER/011/042016 RS.TRAUMA

CENTRE 09/05/2016 03/04/2018

6 1400000000230 RSUD KOTA BAU BAU JL LA ODE MANARFA DINKES KESEHATAN KOTA BAU BAU PER/008/022016 RS.TRAUMA

CENTRE 09/05/2016 01/02/2018

KANTOR CABANG : W02- KANTOR CABANG PALOPO


IKS


1 1500000000097 DR YAIN PANGGALO JL PONGTIKU RANTEPAO 255009811 DR YAIN PANGGALO PER/01/012016RS.TRAUMA CENTRE 01/03/2016 31/12/2016

2 08339 RS BINTANG LAUT PALOPO K. H. M KASIM NO. 5 21302 YAYASAN RATNA MIRIAM


25/02/2016 29/02/2016

KANTOR CABANG : W21- KABUPATEN SINJAI


IKS


1 7-2015740298 RSUD SINJAI JLN JEND SUDIRMAN NO. 47 SINJAI 92611 048221132PEMERINTAH DAERAH KAB SINJAI


16/02/2016 03/01/2018

KANTOR CABANG : X00- KANTOR CABANG BALI DENPASAR


Periode : 01/01/2016 s/d 31/12/2016


147 / 15116-05-201607:59:01



IKS


1 1500000000504 BLK PROPINSI BALI JL IMAM BONJOL 603 DENPASAR UPT BLK-IP BALI PER/08/022016 RS.TRAUMA CENTRE 13/04/2016 28/02/2017

2 1500000000653 BRSUD TABANAN JL. PAHLAWAN NO. 14 TABANAN 82111 811027 DR I NYOMAN SUSILA, M.KES PER/07/022016 RS.TRAUMA

CENTRE 13/04/2016 31/01/2018

3 1400000000484 RS SURYA HUSADHA DENPASAR

JL PULAU SERANGAN NO 7 DENPASAR 233787 PER/02/012016 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

4 1400000000483 RS SURYA HUSADHA UBUNG

JL COKROAMINOTO NO 356 PER/01/2016 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

5 1200000000017 RSU BHAKTI RAHAYU DENPASAR JL GATOT SUBROTO II NO 11 DENPASAR 430270 PUTU IVAN YUNATANA PER/05/012016 RS.TRAUMA

CENTRE 05/01/2016 31/12/2016

6 1400000000554 RSU PARAMA SIDHI JLN. AHMAD YANI NO. 171A SINGARAJA 32701 PER/06/012016RS.TRAUMA CENTRE 08/01/2016 31/12/2016

7 1400000000482 RSU SURYA HUSADHA NUSADUA

JL SILIGITA BLOK I NO 14 NUSA DUA 766154 PER/03/012016 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

8 7-2919990413 RSUD BULELENG JL NGURAH RAI NO 30 SINGARAJA BULELENG

81111 036222046 RSUD BULELENG PER/09/032016 RS.TRAUMA CENTRE

14/04/2016 28/02/2018

9 1400000000485 SILOAM HOSPITAL BALI JALAN SUNSET ROAD NO 818 KUTA 779900 PER/04/012016RS.TRAUMA CENTRE 08/01/2016 31/12/2016

KANTOR CABANG : X01- KANTOR CABANG KUPANG


Periode : 01/01/2016 s/d 31/12/2016


148 / 15116-05-201607:59:01



IKS


1 7-2064672333 KILNIK KUPANG GRAHA MEDIKA

JALAN BUNDARAN PU NOMOR 54C KUPANG 85111 85852420 PT. KUPANG GRAHA

MEDIKAPER/ 008/ 022016

RS.TRAUMA CENTRE 18/02/2016 17/02/2017

2 1100000000003 PROF DR WZ JOHANNES KUPANG JL M HOTTA NO 19 PER/ 016/

032016RS.TRAUMA CENTRE 17/03/2016 15/03/2017

3 1400000000288 RS BHAYANGKARA KUPANG

JL NANGKA 84 KUPANG 85111 821999 POLRI / POLDA NTT PER/ 017/ 102015

RS.TRAUMA CENTRE

22/01/2016 31/12/2016

4 7-3100749143 RS ST CAROLUS BORROMEUS

JL. PROF. H.R KOROH KM 08, BELO, KUPANG

85146 00030530 YAYASAN ELISABETH GRUYTERS

05/PKS/RSCB/IV/2016

RS.TRAUMA CENTRE

27/04/2016 18/04/2017

5 1500000000469 RST WIRASAKTI KOTA KUPANG JALAN MOH HATTA NOMOR 11 KUPANG PER/ 018/

042016RS.TRAUMA CENTRE 27/04/2016 18/04/2017

6 1400000000417RSUD DR TC HILLERS MAUMERE JALAN WAIRKLAU MAUMERE 2426133

PER/ 005/ 012016

RS.TRAUMA CENTRE 28/01/2016 31/12/2016

7 1500000000064 RSUD KAB SABU RAIJUA JALAN TRANS SEBA BOLOU KM 7 MENIA SABU

PER/ 011/ 02016 RS.TRAUMA CENTRE

24/02/2016 24/02/2017

8 1400000000565 RSUD MGR GABRIEL MANEKATAMBUA

JALAN DR SOETOMO NO 02 ATAMBUA 21016 PER/ 003/ 012016

RS.TRAUMA CENTRE

28/01/2016 31/12/2016

9 1400000000394RSUD UMBU RARA MEHA WAINGAPU JALAN ADAM MALIK NO 54 WAINGAPU 61302

PER/ 007/ 012016

RS.TRAUMA CENTRE 01/02/2016 30/01/2017

10 7-2537666813RUMAH SAKIT KATHOLIK MARIANUM HALILALUK

JALAN PAROKI ROH KUDUS HALILALUK ATAMBUA 85713 YAYASAN MARIA VIRGO

PER/ 014/ 032016

RS.TRAUMA CENTRE 17/03/2016 15/03/2017

11 7-2240138189RUMAH SAKIT KRISTEN LINDI MARA

JALAN PROF WZ YOHANNES NOMOR 06 87111 YUMERKRIS PER 010/ 022016RS.TRAUMA CENTRE

24/02/2016 24/02/2017

12 1500000000119 RUMAH SAKIT PANGKALAN TNI AU EL TARI

JL ADI SUCIPTO NO 2 KUPANG 3838123 TNI AU PER/ 004/ 012016

RS.TRAUMA CENTRE

28/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


149 / 15116-05-201607:59:01



IKS


13 1400000000543 RUMAH SAKIT PENYANGGA PERBATASAN BETUN

JALAN SUKABIHANAWA DESA KAMANASAMALAKA TENGAH PER/ 09/ 022016 RS.TRAUMA

CENTRE 15/02/2016 09/02/2017

14 7-2556506581 RUMAH SAKIT UMUM SILOAM JALAN RW MONGINSISI FATULULI OEBOBO 85111 85309000 PT KRISOLIS JAYA

MANDIRIPER/ 015/ 032016

RS.TRAUMA CENTRE 17/03/2016 16/03/2017

15 7-1708103837 SILOAM HOSPITALS LABUAN BAJO

JALAN GABRIEL GAMPUR RT 013 RW 005 DESA GORONTALO KECAMATAN KOMODO LABUAN BAJO

86754 PT LINTAS BUANA JAYA PER/ 006/ 012016

RS.TRAUMA CENTRE

29/01/2016 29/01/2017

16 1500000000438UPT PELATIHAN TENAGA KERJA DINAS NAKERTRANS PROVINSI NTT

JALAN THAMRIN NO 03 KAYU PUTIH 833270 PER/ 013 / 032016

RS.TRAUMA CENTRE

17/03/2016 15/03/2017

KANTOR CABANG : X03- KANTOR CABANG MATARAM


IKS


1 7-2053953083 RS H.L. MANAMBAI ABDULKADIR

JL LINTAS SUMBAWA-BIMA KM 5 KAB SUMBAWA BESAR

84311 803801361 DR H SYAMSUL HIDAYAT


18/02/2016 31/12/2016

2 1400000000433 RSUD BIMA JL LANGSAT NO 1 RABA KOTA BIMA 43142 DRG H IHSAN PER/25/112015RS.TRAUMA CENTRE 29/03/2016 31/12/2016

3 7-2305763363RSUD DR R SOEDJONO SELONG

JL PROF M YAMIN NO 55 SELONG KAB LOMBOK TIMUR 83611 863445444 DR H KARSITO SPPD PER/23/102015

RS.TRAUMA CENTRE 01/03/2016 31/12/2016

4 1400000000513 RSUD KABUPATEN DOMPU JL KESEHATAN NO 01 KAB DOMPU 21411 DR H AHMAD FAISAL PER/05/012016RS.TRAUMA CENTRE

09/05/2016 31/12/2016

5 1400000000396 RSUD KABUPATEN LOMBOKUTARA

JL RAYA TANJUNG - BAYAN, KEC TANJUNG 6147758 DR H LALU BAHARUDIN PER/24/102015 RS.TRAUMA CENTRE

29/03/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


150 / 15116-05-201607:59:01



IKS


6 1500000000061 RSUD KABUPATEN SUMBAWA BARAT JALAN UNDRU NO 6 KEC TALIWANG 8281057 DR HJ DWIWIDIA

MERTASARI PER/03/012016 RS.TRAUMA CENTRE 09/05/2016 31/12/2016

7 7-2043435163 RSUD KOTA MATARAM JALAN BUNG KARNO NO 3 PAGUTAN MATARAM 83117 907545167 DR H.L. HERMAN

MAHAPUTRA MKES PER/02/012016 RS.TRAUMA CENTRE 14/04/2016 31/12/2016

8 1400000000259 RSUD PATUT PATUH PATJU JL H L ANGGRAT BA NO 2 KEC GERUNG 681321 RSUD PATUT PATUH PATJU


09/05/2016 31/12/2016

9 7-2055355604 RSUD PRAYA JL H LALU HASYIM NO 02 KEL TIWU GALI KEC PRAYA KAB LOMBOK TENGAH

83511 75786619 DR MUZAKIR LANGKIR PER/22/112015 RS.TRAUMA CENTRE

18/02/2016 31/12/2016

10 7-2094061443 RSUD PROVINSI NTB JL PRABURANGKASARI DASAN CERMEN MATARAM 83117 081854700

5DR H MAWARDI HAMRY MPPM PER/01/012016 RS.TRAUMA

CENTRE 23/02/2016 31/12/2016

11 7-2306934144 RSUD SUMBAWA JL GARUDA NO 5 SUMBAWA BESAR 84311 909048313 DR SELVI PER/04/012016RS.TRAUMA CENTRE 14/04/2016 31/12/2016

KANTOR CABANG : X04- KANTOR CABANG BALI GIANYAR


IKS


1 1500000000114 KLINIK PENTA MEDIKA JL. RAYA MANGGIS 88 41909DR. A A GEDE YUDI YUNARDHANA PUTRA PER/006/012016

RS.TRAUMA CENTRE 22/01/2016 31/12/2016

2 1400000000395 RSUD KARANGASEM JL. I GUSTI NGURAH RAI AMLAPURA 21470 PER/004/012016RS.TRAUMA CENTRE

29/03/2016 31/12/2016

3 1400000000473 RSUD KLUNGKUNG JL. FLAMBOYAN NO 40 SEMARAPURA 21172 PER/005/012016 RS.TRAUMA CENTRE

22/01/2016 31/12/2016


Periode : 01/01/2016 s/d 31/12/2016


151 / 15116-05-201607:59:01



IKS


4 1400000000321 RSUD SANJIWANI GIANYAR JL. CIUNG WANARA NO. 2 943049 ADD/004/082015 RS.TRAUMA CENTRE 18/01/2016 31/12/2016

5 1400000000321 RSUD SANJIWANI GIANYAR JL. CIUNG WANARA NO. 2 943049 PER/003/012016 RS.TRAUMA CENTRE 22/01/2016 31/12/2017

6 1500000000724 RUMAH SAKIT ARI ÇANTI JL. RAYA MAS UBUD 976508 DR. I WAYAN ARYAWAN PER/009/042016 RS.TRAUMA CENTRE

08/04/2016 31/03/2017

7 7-3047982743 RUMAH SAKIT JIWA PROVINSI BALI

JL. KUSUMA YUDHA NO 29 BANGLI 80611 036691073 DR. GEDE BAGUS DARMAYASA, M.REPRO


25/04/2016 31/12/2017

8 1200000000003 RUMAH SAKIT UMUM GANESHA JL RAYA CELUK,SUKAWATI 298233 DR. GUSTI PUTU

DARMIKA.S.KED PER/002/012016 RS.TRAUMA CENTRE 18/01/2016 31/12/2016

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