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DAFTAR JEJARING TRAUMA CENTER DAN FASILITAS KERJASAMABPJS KETENAGAKERJAAN

Periode : 01012016 s/d 31122016

Halaman : Tanggal Cetak : Waktu Cetak :

1 / 10802-03-201613:40:34

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 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

KANTOR CABANG : 100- KANTOR CABANG SORONG


IKS


1 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

2 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

3 04658 RS MUTIARA JL MALEO NO 2 SORONG0951327433

DR HJ PAHIMAH/ISKANDAR PER/001/012016

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

4 1400000000022 RSAL DR OETOYO (RS TC) JLN JEND AHMAD YANI PER/002/032016RS.TRAUMA CENTRE

01/03/2016 28/02/2017

5 1400000000408 RSUD KAB RAJA AMPAT (RSTC)

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

01/02/2016 31/10/2016

KANTOR CABANG : 101- KANTOR CABANG JAYAPURA


Periode : 01012016 s/d 31122016


2 / 10802-03-201613:40:34



IKS


1 1500000000081 RS MARTHEN INDEY JL. DIPONEGORO NO. 27 GURABESI RSMI JAYAPURA PER/18/122015 RS.TRAUMA CENTRE 14/01/2016 31/12/2016

2 1400000000716 RSAL DR. SOEDIBJO SARDADI JL. AMPHIBI NO. 1 HAMADI 522958 RSAL DR. SOEDIBJO

SARDADI PER/19/122015 RS.TRAUMA CENTRE 14/01/2016 31/12/2016

KANTOR CABANG : A00- KANTOR CABANG LHOKSEUMAWE


IKS


1 1500000000127RUMAH 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

2 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

3 1400000000410 RUMAH 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

4 1400000000322RUMAH SAKIT UMUM BUNDA LHOKSEUMAWE

JL. DARUSSALAM NO. 16 KECAMATAN BANDA SAKTI 46924

DR. HANAFIAH HASAN, SP.OG PER/26/102015

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

5 1400000000691RUMAH 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


Periode : 01012016 s/d 31122016


3 / 10802-03-201613:40:34



IKS


1 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

2 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

3 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

4 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

5 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

6 1500000000055KLINIK KELUARGA ASMAULHUSNA GAMPONG ULEE GLE KEC BANDAR DUA SAIFUL BAHRI IDRIS PER/04/012016

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

7 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

8 1500000001919 KLINIK MITRA MEDISTRA JL. RESIDEN DANUBROTO GP. LAMLAGANGKEC. BANDA RAYA

23111 AZIZURRAHMAN, SKM,MM


10/02/2016 31/12/2016

9 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

10 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

11 1400000000673KLINIK SIWAH MEDIKA CENTER

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

LYDIA SEPTA DESIYANA,M.SI, APT

PER/12/022016RS.TRAUMA CENTRE

10/02/2016 31/12/2016

12 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


Periode : 01012016 s/d 31122016


4 / 10802-03-201613:40:34



IKS


13 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

14 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

15 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

16 1400000000692 RSUD KABUPATEN PIDIE JAYA

JL. BANDA - ACEH KM. 158, MEUREUDU KABUPATEN PIDIE JAYA


10/02/2016 31/12/2016

17 7-2017798742 RSUD ZAINOEL ABIDIN JL. TGK H.M DAUD BEUREUEUH NO 108 BANDA ACEH 23121 60668923 DR. FACHRUL JAMAL, SP.

AN. KIC PER/16/022016 RS.TRAUMA CENTRE 15/02/2016 31/12/2018

18 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

19 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

20 1400000000194 RUMAH 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

21 1400000000570 RUMAH SAKIT U'BUDIYAH 7555750 PT. CAISARIO ROYAL PRATAMA PER/35/122015

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

KANTOR CABANG : A02- KANTOR CABANG LANGSA


Periode : 01012016 s/d 31122016


5 / 10802-03-201613:40:34



IKS


1 1400000000546 DR. 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 1400000000552 KLINIK BINA HUSADA JL. T. CHIK DITIRO NO. 3 GAMPONG PAYA BUJOK TUNONG LANGSA BARO

0853361873663

DR H SYAFRIRUDDIN, MM PER/17/012016 RS.TRAUMA

CENTRE 27/01/2016 31/12/2016

3 1500000000037 PUSKESMAS BANDAR PUSAKA

KECAMATAN BANDAR PUSAKA 085363910858

SYAMSUDDIN, SKM PER/04/012016 RS.TRAUMA CENTRE

21/01/2016 31/12/2017

4 1500000000040 PUSKESMAS SEKERAK KECAMATAN SEKERAK 082168103036

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

21/01/2016 31/12/2017

5 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

6 1400000000340 RSU CUT MEUTIAJL GARUDA NOMOR 1 KEBUN BARU KECAMATAN LANGSA BARO 23071 IR EDDY PURNOMO PER/01/012016

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

7 1400000000675 RSU CUT NYAK DHIEN JL. T.M. BACHRUM NO 1 KOTA LANGSA 22228 DR YUSUF, MM PER/01/012016 RS.TRAUMA CENTRE

18/01/2016 31/12/2016

8 1500000000034 RSUD KOTA LANGSA JALAN JEND. AHMAD YANI NO 1 KOTA LANGSA

22051 DR. HERMAN I PER/18/012016 RS.TRAUMA CENTRE

27/01/2016 31/12/2016

9 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 16/02/2016 31/12/2016

10 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

KANTOR CABANG : A03- KANTOR CABANG MEULABOH


Periode : 01012016 s/d 31122016


6 / 10802-03-201613:40:34



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 : 01012016 s/d 31122016


7 / 10802-03-201613:40:34



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/32/122015 RS.TRAUMA CENTRE

08/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


8 / 10802-03-201613:40:34



IKS


25 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

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 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

34 1500000000136RSUD DR H YULIDDIN AWAY

JL T. BEN MAHMUD NO 86 A, TAPAKTUAN ACEH SELATAN, ACEH 323615 PEMKAB ACEH SELATAN PER/14/122015

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

35 1500000000123RSUD KOTA SUBULUSSALAM

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

62731700PEMKOT SUBULUSSALAM


01/01/2016 31/12/2016

36 1400000000602 RSUD TEUKU UMAR JLN. GUNONG ALI LR. PMI NO.1 CALANG KEC. KRUENG SABEE

23654 2210322 DR. SUZANNA OCTIVA, SP.KJ


01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


9 / 10802-03-201613:40:34



IKS


37 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

38 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 PER/16/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

KANTOR CABANG : B00- KANTOR CABANG MEDAN KOTA


IKS


1 1400000000127 BP HARAPAN BUNDAJL. 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/07/122015 RS.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/20/022016RS.TRAUMA CENTRE 22/02/2016 31/12/2016

6 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

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


Periode : 01012016 s/d 31122016


10 / 10802-03-201613:40:34



IKS


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


22/02/2016 31/12/2016

12 1500000000203 KLINIK 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/25/022016RS.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/02/122015 RS.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/27/022016RS.TRAUMA CENTRE

01/03/2016 31/12/2016

19 1500000000197 KLINIK SENYUM JAYA ABADI

JL SETIABUDI NO 117 LINK V TG SARI 8219006 DRG ERITA FLORA MANURUNG


26/02/2016 31/12/2016


Periode : 01012016 s/d 31122016


11 / 10802-03-201613:40:34



IKS


20 1500000000191 RS ADVENT MEDAN JL GATOT SUBROTO KM 4 MEDAN 4524875 YAYASAN RS ADVENT MEDAN PER/16/022015 RS.TRAUMA

CENTRE 26/02/2016 31/12/2016

21 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

22 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

23 1400000000129 RS ISLAM MALAHAYATI JL. PANGERAN DIPONEGORO NO 2-4 4518766 YAY RS MALAHAYATI PER/03/122015 RS.TRAUMA CENTRE

07/01/2016 31/12/2016

24 1500000000208 RS MARTHA FRISKA MULTATULI

JL MULTATULI KOMP MULTATULI INDAH NO 1 4149666 PT KARYA UTAMA

SEHAT SEJAHTERA PER/29/022016 RS.TRAUMA CENTRE 26/02/2016 31/12/2016

25 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

26 1500000000089 RSU BINA KASIH JL JEND TB SIMATUPANG NO 148 SUNGGAL 8475111 YAYASAN BINA KASIH ABADI


07/01/2016 31/12/2016

27 1500000000091 RSU HERNA MEDAN JL MOJOPAHIT NO 118A MEDAN 4510766 YAY TD PARDEDE FOUNDATION


07/01/2016 31/12/2016

28 1400000000124 RSU MITRA SEJATIJL. AH NASUTION NO. 7 P. MASYHUR MEDAN 7875967 YAY. MITRA SEJATI PER/04/122015

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

29 1500000000090 RSU PROF DR BOLONI JL MONGONSIDI NO 11 MEDAN 4512687YAY PROF DR BOLONI MARPAUNG PER/10/122015

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

30 1500000000092 RSU SARI MUTIARA JL KAPTEN MUSLIM NO 79 MEDAN 8451812YAY SARI MUTIARA MEDAN


07/01/2016 31/12/2016

31 1500000000200 RSU VINA ESTETICA JL SULTAN ISKANDAR MUDA NO 119 4147646 YAYASAN VINA ESTETICA


01/03/2016 31/12/2016


Periode : 01012016 s/d 31122016


12 / 10802-03-201613:40:34



IKS


32 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 ERFI PER/34/TC/012016

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

2 1400000000553 KLINIK MURNI JL MELANTHON SIREGAR NO.206 6204978 APRIMO MP SIBARANIPER/35/TC/012016

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

3 1400000000527 KLINIK PANDU JL. SM. RAJA NO. 627 PERDAGANGAN ANTONIUS PER/36/TC/012016

RS.TRAUMA CENTRE

13/01/2016 31/12/2016

4 1400000000544 KLINIK PUTRI JL SISINGAMANGARAJA NO.20 KEL PARAPAT KEC GIRSANG SIPANGAN BOLON

6474965 DR.AMRAN SITUMORANG

PER/37/TC/012016

RS.TRAUMA CENTRE

13/01/2016 31/12/2016

5 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

6 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

7 1400000000535 RSUD PERDAGANGAN JL.RAJAMIN PURBA ,SH PERDAGANGAN 70324734 RSUD PERDAGANGANPER/29/TC/012016

RS.TRAUMA CENTRE

13/01/2016 31/12/2016

8 1400000000676 RSUD PORSEA JL. RAJA SIPAKKO NAPITUPULU KEC. PORSEA

61245547 PEMERINTAH KAB. TOBASAMOSIR

PER/30/TC/012016

RS.TRAUMA CENTRE

13/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


13 / 10802-03-201613:40:34



IKS


9 1400000000350 RSUD TUAN RONDAHAIM KOMP PEMKAB SIMALUNGUN PEMATANG RAYA 331170 RSUD TUAN

RONDAHAIMPER/31/TC/012016

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

10 1400000000289 RUMAH SAKIT TENTARA JL. GUNUNG SIMANUK MANUK NO. 6 434171 RUMAH SAKIT TENTARA PER/28/TC/012016

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

11 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

12 1400000000343 RUMAH SAKIT UMUM HKBPBALIGE

JL GEREJA NO.17 BALIGE 21043 RSU HKBP BALIGE PER/33/TC/012016

RS.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 7352111DR. NURHIMSYAH JUNEDI NASUTION PER/29/122015

RS.TRAUMA CENTRE 01/12/2016 29/12/2016

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


01/01/2016 31/12/2016

5 1400000000606 KLINIK AULIA DUSUN 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


Periode : 01012016 s/d 31122016


14 / 10802-03-201613:40:34



IKS


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/29/122015 RS.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 PER/30/122015

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

9 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

10 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

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

08126286145

DR PATAR MT PANJAITAN PER/30/122015

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

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

08126286145

DR PATAR MT PANJAITAN


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


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 PER/29/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

16 1500000000665PUSKESMAS 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 LALANG JL. 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


Periode : 01012016 s/d 31122016


15 / 10802-03-201613:40:34



IKS


18 1500000000676 PUSKESMAS LAUTADOR KEC. LAUTADOR KAB. BATU BARA PUSKESMAS LAUTADOR PER/29/122015 RS.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 PER/29/122015 RS.TRAUMA

CENTRE 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

21 1500000000668 PUSKESMAS PEMATANG PANJANG

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

08126470444

PUSKESMAS PEMATANG PANJANG


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 BALAIJL.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


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 KUBUJL. BESAR UJUNG KUBU DUSUN IV KAB. BATU BARA

081361006865

PUSKESMAS UJUNG KUBU PER/29/122015

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

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

44999 MARDI PER/30/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

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

7672018 TOSIP TANJUNG PER/29/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


16 / 10802-03-201613:40:34



IKS


30 1500000001235 RSU TIGA BERSAUDARA JL. 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 HUSADA JL. KARTINI NO. 209 KEL. SENDANG SARI KEC. KOTA KISARAN BARAT 42532 DR. DIAH JULIANA NST PER/30/122015 RS.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

KANTOR CABANG : B03- KANTOR CABANG PADANG SIDEMPUAN


IKS


1 1400000000580 PRAKTEK DOKTER SRI PRIHATIN K N HARAHAP

JL LINTAS GUNUNGTUA-LANGGA PAYUNG DESA SIHOPUK BARU

DR SRI PRIHATIN K N HARAHAP


26/02/2016 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


07/01/2016 31/12/2016

2 1400000000619 BPS KULON PROGO JL. 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 SEHAT JL. JEND SUDIRMAN LK.02 (DEPAN RS SRI PAMELA)

TAN ERFI PER/14/012016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


17 / 10802-03-201613:40:34



IKS


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

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 085359461777

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 1400000000404KLINIK 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 ESSIVA JL. 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/21/012016RS.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


07/01/2016 31/12/2016

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

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

08/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


18 / 10802-03-201613:40:34



IKS


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

DR.DRG SUCI ERAWATI M.KES PER/28/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

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


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 PER/27/012016 RS.TRAUMA

CENTRE 07/01/2016 31/12/2016

21 1400000000709PUSKESMAS BANDAR KHALIPAH

DESA BANDAR KHALIPAH KEC. PERCUT SEITUAN

081362408181 PER/27/012016

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

22 1400000000682 PUSKESMAS BANGUN PURBA

DESA BANGUN PURBA KEC. BANGUN PURBA

085262706056


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-BIRU081262175005 PER/27/012016

RS.TRAUMA CENTRE 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


08/01/2016 31/12/2016

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

08126587680


08/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


19 / 10802-03-201613:40:34



IKS


28 1400000000703 PUSKESMAS GUNUNG MERIAH

DESA GUNUNG MERIAH KEC. GUNUNG MERIAH

081397999343 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

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


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 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

33 1400000000726 PUSKESMAS KUTALIMBARU DESA KUTALIMBARU KEC. KUTALIMBARU081361326400 PER/27/012016

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

34 1400000000710 PUSKESMAS LABUHAN DELI DESA LABUHAN DELI KEC. LABUHAN DELI 081269230222


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. SUNGGAL081375333643 PER/27/012016

RS.TRAUMA CENTRE 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


08/01/2016 31/12/2016

39 1500000000029 PUSKESMAS PANCUR BATU DESA PANCUR BATU KEC. PANCUR BATU 082168463332


08/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


20 / 10802-03-201613:40:34



IKS


40 1400000000700 PUSKESMAS PANTAI LABU DESA PANTAI LABU KEC. PANTAI LABU 081263587546 PER/27/01/2016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

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


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 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

45 1400000000702 PUSKESMAS SEI SEMAYANGJL. 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. SIBOLANGIT 08126420297


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 KENAS081375190502 PER/27/012016

RS.TRAUMA CENTRE 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


08/01/2016 31/12/2016

51 1400000000678 PUSKESMAS TIGA JUHAR DESA TIGA JUHAR KEC. STM HULU 081265818732


08/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


21 / 10802-03-201613:40:34



IKS


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

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


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/02/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

58 1400000000622 RSU MELATI PERBAUNGAN JL. DELI NO. 105-115 PERBAUNGAN 7990056 DR. TONDY PER/07/012016 RS.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 1400000000620RSU SARI MUTIARA LUBUK PAKAM JL. MEDAN NO. 17 LUBUK PAKAM 7951339

DRS. WASHINGTON PURBA PER/04/012016

RS.TRAUMA CENTRE 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 RAMPAH PEMKAB SERDANG BEDAGAI


08/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


22 / 10802-03-201613:40:34


KANTOR CABANG : B05- KANTOR CABANG MEDAN BELAWAN


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/11/2015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

7 7-1135974186KLINIK 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 1500000000251KLINIK HAJI MEDAN PANCING

JALAN WILLIEM ISKANDAR /PANCING NO.100 C

TAKBIR SIREGAR PER/10/2015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

9 1500000000052 KLINIK HELVETIA III JL.KL YOS SUDARSO SP.KANTOR TEGUH SUHARTO PER/06/2015 RS.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/07/2015 RS.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/02/2015

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

12 7-1919381394KLINIK 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


Periode : 01012016 s/d 31122016


23 / 10802-03-201613:40:34



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 04/02/2016 31/01/2017

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 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

17 1400000000336 RS MARTHA FRISKA JALAN KL YOS SUDARSO NO.91 MEDAN RASIN BBA,MHA PER/14/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

18 1400000000455 RSU MITRA MEDIKA JL KL YOS SUDARSO KM 7.5 TJ MULIA DR. HANIFAH, M. KES PER/15/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

19 1400000000335 RUMAH SAKIT IMELDA JALAN BILAL NO.24 P.BRAYAN DR.IMELDA LIANA RITONGA


01/01/2016 31/12/2016

20 1400000000334 RUMAH SAKIT PELABUHAN BELAWAN

JL.STASIUN NO.92 BELAWAN 6941927 PT.PELABUHAN INDONESIA


01/01/2016 31/12/2016

KANTOR CABANG : B06- KANTOR CABANG BINJAI


IKS


1 1500000000067 BPS SARANA JL BINJAI KM 11.7 NO 57 DESA PUJIMULYO SUNGGAL


27/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


24 / 10802-03-201613:40:34



IKS


2 7-1958871584 KLINIK PRATAMA DOA IBU JL SUDIRMAN LINGK II SETIA NO 53 PERDAMAIAN 20811 H BUDIANTO WAHYU

WARDOYO PER/03/022016 RS.TRAUMA CENTRE 10/02/2016 31/12/2016

3 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

4 1500000000213 RS BANGKATAN PTPN II JL SULTAN HASANUDDIN NO 40 BINJAI 75080063 PTPN II PER/09/022016 RS.TRAUMA CENTRE

17/02/2016 31/12/2016

5 7-2048054644 RSU ARTHA MEDICA BINJAI JL SAMANHUDI NO 22 BINJAI 20711 ARUSTA TARIGAN PER/08/022016 RS.TRAUMA CENTRE

17/02/2016 31/12/2016

6 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

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

8 7-2047722993 RSU LATERSIA JL SOEKARNO HATTA NO 451 20731 ROBINSON SEMBIRING PER/07/022016 RS.TRAUMA CENTRE

17/02/2016 31/12/2016

KANTOR CABANG : C00- KANTOR CABANG PADANG


IKS


1 1400000000040 KLINIK ARUM SARI JL SUTAN SYAHRIL NO.332081363474133

DR FERI MULYANI PER/44/122015RS.TRAUMA CENTRE

01/02/2016 31/12/2016

2 1400000000039 RS TENTARA REKSODIWIRYO

JL DR WAHIDIN NO.1 PADANG 31003 DATASEMEN KESEHATAN


01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


25 / 10802-03-201613:40:34



IKS


3 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

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 1400000000239 RSI IBNU SINA SIMPANG AMPEK

JL M. NATSIR PASAMAN BARU SIMPANG EMPAT PASAMAN BARAT

7464015YAYASAN RUMAH SAKITISLAM SUMATERA BARAT


01/01/2016 31/12/2016

4 1400000000239 RSI 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 1400000000063RSUD DR ACHMAD MOCHTAR BUKITTINGGI JL. DR . A. RIVAI BUKITTINGGI 21720

PEMERINTAH PROVINSI SUMATERA BARAT PER/014/122015

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

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


Periode : 01012016 s/d 31122016


26 / 10802-03-201613:40:34



IKS


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 1500000000547 RSUD 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/09/122015RS.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

KANTOR CABANG : D00- KANTOR CABANG PEKANBARU KOTA


Periode : 01012016 s/d 31122016


27 / 10802-03-201613:40:34



IKS


1 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

2 1500000001877 KLINIK FELLITA JL. KAHARUDDIN NASUTION NO. 145-146 MAHARATU MARPOYAN DAMAI 28111 68401901 DR. YANTI FATMI, DK PER/35/072015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

3 1500000001988 KLINIK FIDYA JL. LINTAS TIMUR - PASAR SOREK SATU 72026643 DR. IMAN RANDAL TARIGAN, SP.PD


01/01/2016 31/12/2016

4 1500000001878 KLINIK PELITA HATI JALAN RAYA TALUK KUANTAN DESA LUBUK SAKAT PERHENTIAN RAJA

28411 76892989 FEBRIAN CHASRA,SE.S.FILL


01/01/2016 31/12/2016

5 1500000001770 KLINIK PRATAMA BMC PEKANBARU

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

CENTRE 01/01/2016 31/12/2016

6 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

7 7-522122673 KLINIK PRATAMA TIFFANY MEDIKA

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

01/01/2016 31/12/2016

8 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

9 1500000000241 RSUD SIAK SRI INDRAPURA JL SEI KECIL KABUPATEN SIAK 20012 HJ.ULFAH HANUM PER/08/032015RS.TRAUMA CENTRE 28/02/2016 31/12/2016

10 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

11 1500000001341RUMAH SAKIT PEKANBARU MEDICAL CENTER

JALAN LEMBAGA PEMASYARAKATAN NO. 25 GOBAH, PEKANBARU

848100PT. PEKANBARU MEDIKAL SENTER


01/01/2016 31/12/2016

12 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


Periode : 01012016 s/d 31122016


28 / 10802-03-201613:40:34


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

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 077836147

5PT AUDY JAYA PRATAMA PER/47/122015 RS.TRAUMA

CENTRE 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/48/122015RS.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 MEDIKA JL 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/60/122015

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


Periode : 01012016 s/d 31122016


29 / 10802-03-201613:40:34



IKS


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

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/01/012016RS.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/65/122015 RS.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 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 : 01012016 s/d 31122016


30 / 10802-03-201613:40:34



IKS


2 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

3 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

4 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

5 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

6 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

7 1400000000492 RS CAHAYA JL LINTAS RIAU UJUNG TANJUNG 28983 66818300DRG CAHAYA PURNAMASARI PER/49/122015

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

8 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 : D05- KANTOR CABANG DURI


IKS


1 7-1704752493 KLINIK PRATAMA BERKAH JALAN LINTAS DURI – PEKANBARU DESA PINGGIR

28784 AFRIZAL TANJUNG 7-1704752493RS.TRAUMA CENTRE

17/02/2016 31/12/2016

2 7-1704752493 KLINIK PRATAMA BERKAH JALAN LINTAS DURI – PEKANBARU DESA PINGGIR

28784 AFRIZAL TANJUNG 7-1704752493 RS.TRAUMA CENTRE

02/02/2016 31/12/2016


Periode : 01012016 s/d 31122016


31 / 10802-03-201613:40:34


KANTOR CABANG : D07- KANTOR CABANG BATAM SEKUPANG


IKS


1 1400000000574 KLINIK DUNIA MEDICAL CENTRE

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

3581242 DR KON SAN PER/04/022016 RS.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 077835829

23 RIRIS LIANI PER/02/012016 RS.TRAUMA CENTRE 05/01/2016 03/01/2017

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

KANTOR CABANG : E01- KANTOR CABANG MUARO BUNGO


Periode : 01012016 s/d 31122016


32 / 10802-03-201613:40:34



IKS


1 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

2 1400000000053 RSUD CHATIB QUZWAIN SAROLANGUN

JL. LINTAS SUMATERA KM.09 DESA BUKIT,SAROLANGUN DR IRWAN MISWAR PER/01/032016 RS.TRAUMA

CENTRE 01/03/2016 28/02/2017

KANTOR CABANG : G00- KANTOR CABANG PALEMBANG


IKS


1 1500000000183RS MUHAMMADIYAH PALEMBANG

JL A. YANI RT.028 RW. 001 KELURAHAN 13 ULU KECAMATAN SEBRANG ULU II 513144

DR. H. YUDI FADILAH, SPPD, FINASIM PER/03/012015

RS.TRAUMA CENTRE 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 1500000001101 UPTD 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

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


Periode : 01012016 s/d 31122016


33 / 10802-03-201613:40:34



IKS


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 1400000000729 RUMAH 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 1500000001268 BALAI LATIHAN KERJA KAB.MUARA ENIM

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

28/01/2016 28/01/2017

2 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

3 1500000001202BALAI LATIHAN KERJA KOTA PRABUMULIH JL JEND SUDIRMAN KM 35 320618 KOTA PRABUMULIH PER/42/062015

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

KANTOR CABANG : H00- KANTOR CABANG BANDAR LAMPUNG


Periode : 01012016 s/d 31122016


34 / 10802-03-201613:40:34



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 : 01012016 s/d 31122016


35 / 10802-03-201613:40:34



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 01/03/2016 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


01/03/2016 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 01/03/2016 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/03/012015

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


KABUPATEN PESAWARAN PER/02/022016

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


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


01/03/2016 28/02/2017


Periode : 01012016 s/d 31122016


36 / 10802-03-201613:40:34


KANTOR CABANG : H01- KANTOR CABANG LAMPUNG TENGAH


IKS


1 7-1568007187 RS YUKUM MEDICAL CENTRE

JL. NEGARA NO. 99 KM 67 YUKUM JAYA KEC. TERBANGGI BESAR

34163 072525333 PT. MITRA MEDICAL CENTER


22/02/2016 31/01/2017

KANTOR CABANG : J00- KANTOR CABANG JAKARTA SALEMBA


IKS


1 1400000000298 RS PERTAMINA JAYA JL.JEND.ACHMAD YANI NO 2 CEMPAKA PUTIH


05/01/2016 31/12/2016

2 1400000000351 RSIA EVASARI JL. RAWAMANGUN NO. 27 PRAMUKA JAKARTA PUSAT 10570 4202851 PER/02/012016 RS.TRAUMA

CENTRE 05/01/2016 31/12/2016

KANTOR CABANG : J03- KANTOR CABANG JAKARTA KELAPA GADING


IKS


1 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 : 01012016 s/d 31122016


37 / 10802-03-201613:40:34



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

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


IKS


1 1500000000145 KLINIK PRATAMA MH THAMRIN CENGKARENG

JL DAAN MOGOT KM 17 NO 69 RT02/04 KLDRS


01/02/2016 31/01/2017


Periode : 01012016 s/d 31122016


38 / 10802-03-201613:40:34



IKS


2 7-1459450363 RS HERMINA DAAN MOGOT JL KINTAMANI RAYA NO 2 DAAN MOGOT BARU 11710 DR I ICHSAN HANAFI

MARS PER/004/012016 RS.TRAUMA CENTRE 22/01/2016 17/01/2017

3 1500000000146 RS KARANG TENGAH MEDIKA

JL KARYAWAN IV CILEDUG KARANG TENGAH 7336699 PER/005/012016 RS.TRAUMA

CENTRE 01/02/2016 31/01/2017

KANTOR CABANG : J12- KANTOR CABANG JAKARTA PULOGADUNG


IKS


1 7-1362178499 RS HARAPAN JAYAKARTAJL BEKASI TIMUR RAYA NO.6 KM 18 PULOGADUNG 13210 46822879 DR. SRI HARTATI

PER/TC/01/012016

RS.TRAUMA CENTRE 11/01/2016 31/12/2016

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


04/01/2016 31/12/2016

3 1500000000834 KLINIK KIMIA FARMA 51 JL.IR.H.JUANDA 69 BANDUNG 4203331 PT 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


Periode : 01012016 s/d 31122016


39 / 10802-03-201613:40:34



IKS


5 1500000000836 KLINIK KIMIA FARMA SINDANGLAYA JL. SUKAMISKIN 126B BANDUNG 7178664 PT KIMIA FARMA

(PERSERO) TBK PER/13/012016 RS.TRAUMA CENTRE 04/01/2016 31/12/2016

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 DUAJL. 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/07/012016 RS.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 7305019PT KIMIA FARMA (PERSERO) TBK PER/10/012016

RS.TRAUMA CENTRE 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

7237337DRG YUDHIASTUTI NUNING HARINI


04/01/2016 31/12/2016

16 1500000000600 KLINIK PRATAMA SELAMAT JL. TERUSAN BUAH BATU NO. 227 BANDUNG

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

04/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


40 / 10802-03-201613:40:34



IKS


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

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

YAYASAN RUMAH SAKITISLAM-KSWI JAWA BARAT

PER/18/012016 RS.TRAUMA CENTRE 04/01/2016 31/12/2016

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 7322468 PER/21/012016 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

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

23 1500000001399 RS. SALAMUN JL. CIUMBELUIT NO. 203, BANDUNG, JAWA BARAT, 40142

2032090 DR. BAMBANG S. GUNADI, SP.RAD., MARS.,


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 4231550DR. LILIAN MELATTIE E. NORE PER/25/012016

RS.TRAUMA CENTRE 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 1500000001936 RSUP HASAN SADIKIN BANDUNG

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

04/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


41 / 10802-03-201613:40:34


KANTOR CABANG : K01- KANTOR CABANG BEKASI KOTA


IKS


1 1500000000698 KLINIIK TC ANNISA JL RAYA KAMPUNG BARU KEMANG RT 03/04 JATIBENING BARU PD GEDE BEKASI


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 PER/18/052015 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

4 1500000000744 KLINIK TC MAHADINA JL RAYA SELANG JATI RT 03/03 WANAJAYACIBITUNG PER/22/052015 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

5 1500000000913 KLINIK TC MH THAMRIN BEKASI

JL HM JOYOMARTONO NO 31B BEKASI TIMUR


04/01/2016 31/12/2016

6 1500000001328 KLINIK TC SETO HASBADI 01 JL 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 02JL 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 06JL RAYA IMAM BONJOL NO 01 TELAGA ASIH CIKARANG BARAT

PER/30C/062015RS.TRAUMA CENTRE

04/01/2016 31/12/2016

9 1500000001254 KLINIK TC SRITINA JL IMAM BONJOL NO 8 RT 01/01 TELAGA MURNI CIKARANG BARAT


04/01/2016 31/12/2016

10 1400000000121 RSTC CIBITUNG MEDIKA J LRAYA BOSIH NO.117 CIBITUNG 88323444 PT ADHI PUTRA MEDIKA PER/01/012016 RS.TRAUMA CENTRE

09/02/2016 31/12/2016

11 1400000000121 RSTC CIBITUNG MEDIKA J LRAYA BOSIH NO.117 CIBITUNG 88323444 PT ADHI PUTRA MEDIKA PER/19/052015RS.TRAUMA CENTRE 04/01/2016 31/12/2015

12 1100000000020 RSTC HOSANA MEDICAJL PRAMUKA NO.12 RAWA LUMBU NAROGONG 8221570 JOHANES POSO PER/27/062015

RS.TRAUMA CENTRE 04/01/2016 31/12/2015


Periode : 01012016 s/d 31122016


42 / 10802-03-201613:40:34



IKS


13 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 CENTER JL 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 MULIAJL 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/22/012016 RS.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/23/012016

RS.TRAUMA CENTRE 29/01/2016 31/12/2016

7 7-1670259391 KLINIK PERMATA HUSADA JL.RAYA BABAKAN MADANG NO.10 16810 87952811DRG.WIWIK DWI ARYANI, MARS


04/02/2016 31/12/2016

8 1500000001536 PUSKESMAS JASINGA JL.LET.SAYUTI JASINGA 085780041002


25/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


43 / 10802-03-201613:40:34



IKS


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


25/01/2016 31/12/2016

13 1400000000286 RS ISLAM BOGOR JALAN PERDANA RAYA NO 22 8316822 YYS RS ISLAM BOGOR PER/26/012016 RS.TRAUMA CENTRE 29/01/2016 31/12/2016

14 1400000000284 RS KARYA BHAKTI PRATIWI JALAN RAYA DRAMAGA KM 7 8626868YYS KARYA BHAKTI PRATIWI PER/02/012016

RS.TRAUMA CENTRE 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/13/012016 RS.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/11/012016

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

19 1400000000333 RS TRIMITRAJL RAYA JAKARTA BOGOR KM 43 CIBINONG

8763055 DR EMA SUMARSAH PER/05/012016RS.TRAUMA CENTRE

25/01/2016 31/12/2016

20 1500000000637 RS VANIA JL SILIWANGI NO 11 KEL SUKASARI BOGORTIMUR


25/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


44 / 10802-03-201613:40:34



IKS


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/15/012016 RS.TRAUMA CENTRE 25/01/2016 31/12/2016

26 1400000000414SALSABILLA 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 55781888

DR. DEDI TEDJAKUSNADI, MARS PER/68/122015

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

2 1400000000650 RS BHAKTI ASIHJL RADEN SALEH NO 10 KARANG TENGAH TANGERANG

7305662 YAYASAN BHAKTI ASIH PER/67/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

3 1400000000652 RS. SARI ASIH CILEDUG JL HOS COKROAMINOTO NO 38 CILEDUG 7333430PT. SARI ASIH PUTRA MANDIRI, DICKY R H PAMUNGKAS


01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


45 / 10802-03-201613:40:34



IKS


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 5460055

PT. SILOAM INTERNATIONAL HOSPITALS


6 1500000000465 RS. USADA INSANI JL. K.H HASYM ASHARI NO. 24 TANGERANG 55752575 PT. SURYA MITRA INSANI


01/01/2016 31/12/2016

KANTOR CABANG : K05- KANTOR CABANG SERANG


IKS


1 1500000000330 BP PERMATA HUSADA JL LETJEND SUPRAPTO NO 45 CILEGON WAWAN MULYANA PER/07/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

2 1500000001467 KLINIK 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/08/012016

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

4 1500000000254 KLINIK MEDIKA JL JEND AHAMD YANI NO.56 209975 DR. DIANAHAN PER/05/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

5 1500000000107KLINIK MODERN MEDIKA CIKANDE

RUKO B6 KOMP MODERN INDUSTRI CIKANDE JL RAYA SERANG KM 68

400554 PT MODERN MEDIKA PER/03/012016RS.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


Periode : 01012016 s/d 31122016


46 / 10802-03-201613:40:34



IKS


7 1500000000329 RS HERMINA CIRUAS JL RAYA SERANG JAKARTA KM 9 CIRUAS 280555 HERMINA HOSPITAL GROUP PER/09/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

8 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

9 1400000000082 RSUD BANTEN JL SYECH NAWAWI AL-BANTANI 8490911 PROVINSI BANTEN PER/010/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

10 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

11 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 224128PER/14/TC/12/2015

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

2 1400000000671 RSUD CIMACAN JL. RAYA CIMACAN NO. 17 CIPANAS 512465PER/15/TC/122015

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

3 1500000000060 RSUD PELABUHAN RATU JL. A. YANI NO. 2 PELABUHAN RATUPER/20/TC/122015

RS.TRAUMA CENTRE

01/01/2016 31/12/2016

KANTOR CABANG : K07- KANTOR CABANG TASIKMALAYA


Periode : 01012016 s/d 31122016


47 / 10802-03-201613:40:34



IKS


1 1400000000593 RUMAH 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


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/20/102015RS.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 MEDIKAJL AHMAD YANI NO 100 DAWUAN CIKAMPEK

8862936MUHAMMAD 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/24/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


48 / 10802-03-201613:40:34



IKS


5 1500000000846 KLINIK GEMPOL JL 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 1500000001515 KLINIK GRAHA MEDIS CIKAMPEK JL A. YANI NO 51 DAWUAN TIMUR 310101 DR. HJ. DYAH PERMATA

S.M.KES PER/12/012016 RS.TRAUMA CENTRE 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

8 1500000001518 KLINIK GRAHA MEDIS KOSAMBI

JL RAYA KOSAMBI NO 23 DESA DUREN KLARI

435527 DR.H. SUNUHARDO EP, M.KES


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 SEHATJL. RAYA KOSAMBI CURUG NO 28 KARAWANG 433930

DR. YUNITA PUSPITASARI PER/19/012016

RS.TRAUMA CENTRE 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 YAKESTIJL RAYA KLARI RT 01/02 GINTUNG KERTA KLARI KARAWANG 432416

MUHAMMAD SAFEI'I MA'ARIF PER/22/012016

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

15 1500000001714 KLINIK YASMIN JL IR H JUANDA KM2 KOTA BARU RT 02/05 41311 SAFRINA DEWI PER/23/012016RS.TRAUMA CENTRE

12/01/2016 31/12/2016

16 1500000000849 LIRA MEDIKA JL SYECH QURO NO 14 PALUMBONSARI 8452555 NY ANGELIAQUE ARYANTO


12/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


49 / 10802-03-201613:40:34



IKS


17 7-1272337870 RS BAYU KARTA JL. KERTABUMI NO 44 KARAWANG 41311 0267401818 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/03/012016 RS.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

20 1500000001708 RS DELIMA ASIH SISMA MEDIKA

JL WIRASABA NO 54 JOHAR KEC KARAWANG TIMUR

41311 403073 PT DELIMA SISMA MEDIKA


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 IZZAJL RAYA CISELANG DESA CIKAMPEK UTARA KECAMATAN KOTA BARU 8386830

DR MED H LUQMAN ADJISAPTOGINO, SP RAD (K) DAN SP KN

PER/07/012016RS.TRAUMA CENTRE 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 01/03/2016 31/12/2016

26 06823RSU DELIMA ASIH SISMA MEDIKA JL WIRASABA NO 54 JOHAR 403073 PER/04/012016

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

27 7-1277095197RUMAH SAKIT FIKRI MEDIKA

JL. RAYA KOSAMBI TELAGASARI KM 3 41314 H SAEPUDIN PER/02/012015RS.TRAUMA CENTRE

05/01/2016 30/06/2016

KANTOR CABANG : K13- KANTOR CABANG TANGERANG CIKUPA


Periode : 01012016 s/d 31122016


50 / 10802-03-201613:40:34



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 BANTEN JL 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 1500000001309 KLINIK 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 MEDIKA JL. RAYA SERANG KM.14,8 KOMP RUKO B/16 CIKUPA

MUSAFAH PKS/34/122015 RS.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

9 1500000001504KLINIK 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


Periode : 01012016 s/d 31122016


51 / 10802-03-201613:40:34



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 7-1254255963 KLINIK KASIH ANUGERAH SERANG BARU

JL. RAYA CIBARUSAH, KP.BUNISARI RT.007/004, DESA SUKARAGAM, KEC. SERANG BARU , KABUPATEN BEKASI

17530 DR 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 7-1254255965 RS DR SANDER.B JL. KH.DEWANTARA NO.33 CIKARANG UTARA, KABUPATEN BEKASI 17340 DR. HASAN PER/59/122015 RS.TRAUMA

CENTRE 05/01/2016 30/11/2016

6 7-1250333673RS 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

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 KOPOJL KOPO NO. 59 PANJUNAN - KOTA BANDUNG

40241 5232291 PT. AVIATI PRIMA CITRA PER/09/012016RS.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


Periode : 01012016 s/d 31122016


52 / 10802-03-201613:40:34



IKS


4 1500000001538 KLINIK 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 KATAPANG JL 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 1500000001537 KLINIK LUHUR MEDICA CENTRE

JL JEND SUDIRMAN NO 472/474 ANDIR - BANDUNG

40182 6037679 CV 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

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 2JL 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/07/012016RS.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 1400000000080RSUD AL IHSAN PROV. JABAR

JL KIASTRAMANGGALA - BALEENDAH 40258 5940872 PEMDA PROVINSI JABAR PER/02/012016RS.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


Periode : 01012016 s/d 31122016


53 / 10802-03-201613:40:34



IKS


16 1500000001540 RUMAH 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 1500000001715 SANTOSA HOSPITAL BANDUNG CENTRAL JL KEBONJATI NO 38 BANDUNG 40181 4248555 PT SANBE PRAKARSA


18 1500000001388 SANTOSA HOSPITAL BANDUNG KOPO

KH. WAHID HASYIM NO 461- 463 KOPO BANDUNG

40221 54280555 PT SANBE PRAKARSA HUSADA


01/01/2016 31/12/2016

KANTOR CABANG : K16- KANTOR CABANG BOGOR CILEUNGSI


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


25/01/2016 31/12/2016

3 1500000001382 KLINIK DR IRMANPERUM GRIYA ALAM SENTOSA BLOK C9 NO 4 RT 10/08 PASIRANGIN CILEUNGSI

YAYASAN SUMARNO MEDIKA PER/08/012016

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

4 1500000001207 KLINIK DR. MARZUKI JL RAYA CILEUNGSI JONGGOL KM 2,2 DR MARZUKI PER/05/012016RS.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/12/012016RS.TRAUMA CENTRE

25/01/2016 31/12/2016

6 1500000001690 KLINIK EKA MEDIKA JL RAYA NAROGONG NO 116 KLAPANUNGGAL

16820 29289475 DR HARUMITI RAMIL,MKK


25/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


54 / 10802-03-201613:40:34



IKS


7 1500000001687 KLINIK GRACIA JL RAYA NAROGONG KM 17 DESA CILEUNGSI 16820 SURYATI SARI ARUM,

SKOM PER/10/012016 RS.TRAUMA CENTRE 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 PER/06/012016 RS.TRAUMA CENTRE 25/01/2016 31/12/2016

9 1500000001383 KLINIK 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/01/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

11 1500000001927 RS PERMATA JONGGOL JL RAYA JONGGOL NO 1 A SUKAMANAH JONGGOL 16120 89931333 DR EVY FEBRINA

NURPENI, MARS PER/03/012016 RS.TRAUMA CENTRE 25/01/2016 31/12/2016

12 1400000000327RSTC 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

KANTOR CABANG : K17- KANTOR CABANG TANGERANG CIMONE


IKS


1 1500000000649 RS DINDA GALUH NO 2 JATIUWUNG 15133 PT DINDA MEDISTRA PER/04/042016RS.TRAUMA CENTRE 26/01/2016 31/12/2016

2 1500000000649 RS DINDA GALUH NO 2 JATIUWUNG 15133 PT DINDA MEDISTRA PER/04/012016RS.TRAUMA CENTRE

26/01/2016 31/12/2016

3 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


Periode : 01012016 s/d 31122016


55 / 10802-03-201613:40:34



IKS


4 1100000000005 RSU ARIYA MEDIKA JL 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

2 1500000001808 KLINIK IRENK MEDIKA JL BAHAGIA RAYA NO 18 DEPOK TIMUR 16413 7715039ARUJI 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 7520082THAMAS INVESTAMA GUNA PER/27/122015

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

6 1400000000183RS 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/28/122015RS.TRAUMA CENTRE

04/01/2016 31/12/2016

8 1500000001916 RS PERMATA DEPOK JL RAYA MUCHTAR NO.22 SAWANGAN DEPOK

16511 29669000 PT MUFIDAH MEDIKA SAWANGAN


04/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


56 / 10802-03-201613:40:34



IKS


9 1400000000181 RS 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

10 1400000000182 RS SIMPANGAN DEPOK JL RAYA JAKARTA BOGOR KM 36 SUKAMAJU DEPOK D WARSITO PER/24/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

11 1400000000180 RS TUGU IBU JL RAYA JAKARTA BOGOR KM 29 CIMANGGIS DEPOK

8710870 H MARIS RINALDI PER/23/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

12 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

KANTOR CABANG : K19- KANTOR CABANG TANGERANG BSD


IKS


1 7-1679975283 RS OMNI ALAM SUTERA JL ALAM SUTERA BOULEVARD KAV 25 SERPONG

15325 53125555 PT SARANA MEDITAMA INTERNATIONAL


01/02/2016 31/01/2017

KANTOR CABANG : L00- KANTOR CABANG SEMARANG PEMUDA


IKS


1 7-1435412603 PUSKESMAS BRATI JL. RAYA KUDUS KRONGGEN PURWODADI NO. 20, KEC. BRATI

58153 085290455655

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


Periode : 01012016 s/d 31122016


57 / 10802-03-201613:40:34



IKS


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 PER/22-4/112015 RS.TRAUMA

CENTRE 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 58162 0292659322

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 PER/22-7/112015 RS.TRAUMA

CENTRE 18/01/2016 31/12/2016

8 7-1444574355 PUSKESMAS GROBOGAN JL. PUGER NO.160, KEC. GROBOGAN 5815202927703006 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 58164 0292533326

DR. ARIEF GUNAWAN PER/22-9/112015 RS.TRAUMA CENTRE

18/01/2016 31/12/2016

10 7-1444853077 PUSKESMAS GUBUG II JL. 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 58163

AGUNG DWI SUJATMOKO, SKM

PER/22-11/112015

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

12 7-1445380831PUSKESMAS 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

13 7-1445437092 PUSKESMAS KEDUNGJATI JL. RAYA KEDUNGJATI, KEC. KEDUNGJATI 581670292658088

DR. HARDJOKOPER/22-13/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

14 7-1445504163 PUSKESMAS KLAMBU DS. KLAMBU, KEC. KLAMBU 58154 081575586160

SIGIT TYASMONO, SKM PER/22-14/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


58 / 10802-03-201613:40:34



IKS


15 7-1445537804 PUSKESMAS KRADENAN I JL. SURYOJENGGOLO 16 KUWU, KEC. KRADENAN 58182 029276124

1 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-

16/112015RS.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 7-1445782077 PUSKESMAS 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, MMPER/22-19/112015

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

20 7-1445943179 PUSKESMAS PULOKULON IJL. 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 II JL. 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 58111 0292421541

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 7-1446397684PUSKESMAS TANGGUNGHARJO

DS. TANGGUNGHARJO NO. 12A, KEC. TANGGUNGHARJO 58166 DR. KUSAINI

PER/22-24/112015

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

25 7-1446533475PUSKESMAS TAWANGHARJO

JL. RAYA PURWODADI BLORA POJOK, KEC. TAWANGHARJO

58191 DRG. RENDRA MPER/22-25/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

26 7-1446647286 PUSKESMAS TEGOWANU JL. GATOT SUBROTO NO. 128, KEC. TEGOWANU

58165 02925135150

DR. EKO TAKARIYANTO PER/22-26/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


59 / 10802-03-201613:40:34



IKS


27 7-1446759157 PUSKESMAS TOROH I JL. RAYA SOLO 171 DS. DEPOK, KEC. TOROH 58171 0292552192 AGUS SETIJORINI, SKM PER/22-

27/112015RS.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 II JL 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 641870DRG EDI SUMARWANTO MM MH KES PER/25/122015

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

33 1400000000217 RS PELITA ANUGERAH JL 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/31/122015 RS.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 1500000000211RSUD DR R SOEDJATI SOEMODIARDJO JL DI PANJAITAN 36 PURWODADI 421004

DR BAMBANG PUJIYANTO M.KES PER/30/122015

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

37 1400000000216 RSUD KOTA SEMARANG JL FATMAWATI NO 1 SEMARANG 6711500 PER/29/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

38 1400000000214 RSUD TUGUREJO JL. RAYA TUGUREJO KM 9 TAMBAK AJI NGALIYAN


01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


60 / 10802-03-201613:40:34


KANTOR CABANG : L01- KANTOR CABANG SURAKARTA


IKS


1 1500000000142 KLINIK GRIYA HUSADA 1 JL. MEKARSARI RT 03 RW 01 POPONGAN KARANGANYAR

6499639 DR HADIASRI WIDIYASARI


11/01/2016 31/12/2016

2 1500000001791 KLINIK NAYAKA HUSADA 07KARANGANYAR

JL RAYA SOLO SRAGEN KM 10 DAWUNG RT02/01 DESA KEMIRI KEBAKKRAMAT 57171 PT NAYAKA ERA


3 1500000001215 KLINIK NGESTI HUSADA JATI JL SUMPAH PEMUDA NO. G KADIPIRO DR DEVI FIKASARI PER/27/012016 RS.TRAUMA

CENTRE 11/01/2016 31/12/2016

4 1400000000516 KLINIK NGUDI SEHAT JL. TENTARA PELAJAR NO. 31 SANGGRAHAN GROGOL SUKOHARJO 2974269 SUHADI PER/18/012016 RS.TRAUMA

CENTRE 11/01/2016 31/12/2016

5 1500000000106 KLINIK NGUDI SEHAT PARANGJORO

SINGKIL RT 03 RW 08 PARANGJORO GROGOL SUKOHARJO

2974269 KLINIK NGUDI SEHAT PARANGJORO


11/01/2016 31/12/2016

6 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

7 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

8 1100000000033 RS DR OEN SURAKARTA JL. BRIGJEND KATAMSO 55 643139 YYS PANTI KOSALA PER/12/012016RS.TRAUMA CENTRE

11/01/2016 31/12/2016

9 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

10 1100000000034 RS KASIH IBU SURAKARTA JL SLAMET RIYADI 404 714422 YYS KASIH IBU PER/08/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

11 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

12 1100000000032 RS KUSTATI JL KAPT MULYADI 249 643013 PER/09/012016RS.TRAUMA CENTRE 11/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


61 / 10802-03-201613:40:34



IKS


13 1400000000536 RS NIRMALA SURI SUKOHARJO JL SOLO SUKOHARJO KM 9 RS NIRMALA SURI

SUKOHARJO PER/19/012016 RS.TRAUMA CENTRE 15/01/2016 31/12/2016

14 1100000000035 RS ORTHOPEDI PROF DR SOEHARSO JL. JEND A YANI PABELAN 714458 PER/02/012016 RS.TRAUMA

CENTRE 25/01/2016 31/12/2016

15 1100000000031 RS PANTI WALUYO JL A YANI 1-2 712077 PER/15/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

16 1500000000294 RS PKU MUHAMADIYAH SELOGIRI

JL LAMA NAMBANGAN SELOGIRI WONOGIRI

5327504 YYS PKU MUHAMADIYAH


11/01/2016 31/12/2016

17 1400000000537 RS PKU MUHAMADIYAH SURAKARTA JL RONGGOWARSITO NO 130 SURAKARTA 714578 RS PKU MUHAMADIYAH

SURAKARTA PER/20/012016 RS.TRAUMA CENTRE 11/01/2016 31/12/2016

18 1500000001946RS PKU MUHAMMADIYAH KARANGANYAR

JL PAPAHAN DESA PAPAHAN KECAMATAN TASIKMADU 57171 492685

YAYASAN MUHAMADIYAH PER/31/012016

RS.TRAUMA CENTRE 11/01/2016 31/12/2016

19 1500000001628 RS PKU MUHAMMADIYAH SRAGEN

JL RAYA SOLO SRAGEN KM 8 MASARAN SRAGEN

YAYASAN MUHAMADIYAH


01/06/2016 31/12/2016

20 08237 RS PKU MUHAMMADIYAH SURAKARTA

JL RONGGOWARSITO SURAKARTA 714578 RS PKU MUHAMADIYAH SURAKARTA


29/01/2016 31/12/2016

21 1500000001531 RSI AMAL SEHAT SRAGEN JL VETERAN NO 35 SRAGENYAYASAN AMAL SEHAT SRAGEN PER/25/012016

RS.TRAUMA CENTRE 15/01/2016 31/12/2016

22 7-1689398627RSO PROF DR R SOEHARSO SURAKARTA JL A AYANI KARTASURA 50771 71445832 KEMENKES PER/02/012016

RS.TRAUMA CENTRE 29/01/2016 31/12/2016

23 1500000000121RSU JATI HUSADA KARANGANYAR

JL RAYA SOLO TAWANGMANGU KM 10,3 JATI JATEN KARANGANYAR

PT TENTERAM MAKMUR BERSAMA


11/01/2016 31/12/2016

24 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


Periode : 01012016 s/d 31122016


62 / 10802-03-201613:40:34



IKS


25 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

26 1100000000036 RSUD DR MOEWARDI SURAKARTA JL KOL SUTARTO 132 634634 PER/03/012016 RS.TRAUMA

CENTRE 11/01/2016 31/12/2016

27 1500000000120 RSUD DR SOEHADI PRIJONEGORO SRAGEN

JL RAYA SUKOWATI 534 SRAGEN PER/13/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

28 1400000000424 RSUD KABUPATEN KARANGANYAR

JL. LAKSDA YOS SUDARSO 495673 RSUD KABUPATEN KARANGANYAR


11/01/2016 31/12/2016

29 1400000000425 RSUD KABUPATEN SUKOHARJO JL DR MOEWARDI 71 SUKOHARJO 593118 RSUD KABUPATEN

SUKOHARJO PER/05/012016 RS.TRAUMA CENTRE 11/01/2016 31/12/2016

30 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

KANTOR CABANG : L02- KANTOR CABANG CILACAP


IKS


1 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

2 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 : 01012016 s/d 31122016


63 / 10802-03-201613:40:34



IKS


1 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

2 1500000000048 INIK 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

3 1500000000062 KLINIK PRATAMA SWA JL SALAK/TURI KM 4 KADISOBO II RT 02 RW03 TRIMULYO

7485660 YAYASAN SWA YOGYAKARTA


01/01/2016 31/12/2016

4 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

5 1400000000005 RS PKU MUHAMMADIYAH BANTUL JL. JEND SUDIRMAN NO.124 368238 YAYASAN

MUHAMMADIYAH PER/45/122015 RS.TRAUMA CENTRE 18/01/2016 31/12/2016

6 1400000000136 RS QUEEN LATIFAJL RING ROAD BARAT MLANGI NOGOTIRTOGAMPING 581402 PER/48/122015

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

7 1400000000478 RSU 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

8 1500000000349 RSU PURI HUSADA JLN PALAGAN TENTARA PELAJAR KM 11 NO.67 SARIHARJO, NGAGLIK

867270 PT. HUSADA EDUKA HOLISTIKA


01/02/2016 31/01/2017

9 1500000000327 RSUD KOTA YOGYAKARTA JL WIROSABAN NO.1 YOGYAKARTA 371195 PEMKOT YOGYAKARTA PER/01/012016RS.TRAUMA CENTRE 01/02/2016 31/01/2017

10 1400000000475 RSUD WATES JL TENTARA PELAJAR KM 1 NO 5 773169 PEMDA KULON PROGO PER/43/122015RS.TRAUMA CENTRE 18/01/2016 31/10/2016

11 1400000000479RUMAH SAKIT AKADEMIK UNIVERSITAS GADJAH MADA

JL KABUPATEN KRONGGAHAN TRIHANGGO GAMPING

4530404UNIVERSITAS GADJAH MADA


18/01/2016 30/11/2016

12 1400000000315 RUMAH SAKIT ISLAM YOGYAKARTA PDHI

JL SOLO KM 12,5 KALASAN SLEMAN 498000 PROF.DR.DR.H LAMSUDIN


01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


64 / 10802-03-201613:40:34



IKS


13 1400000000480 RUMAH 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

14 1400000000695 RUMAH SAKIT NUR ROHMAH

JL WONOSARI-YOGYA KM 7 BANDUNG PLAYEN 394574 PT.RAHMA BAKTI


15 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

KANTOR CABANG : L04- KANTOR CABANG PEKALONGAN


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 MUHAMMADIYAHJL 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 7-1073301393 KLINIK 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


Periode : 01012016 s/d 31122016


65 / 10802-03-201613:40:34



IKS


2 1500000000138 RSI 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

3 05896 RSK MARDI RAHAYU JL AKBP R AGIL KUSUMADYA NO 110 KUDUS 434707

YAYASAN KRISTEN KESEJAHTERAAN MARDIRAHAYU


4 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

5 1500000000164 RSU 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

6 7-1061786476 RSUD DR LOEKMONO HADI KUDUS JL DR LOEKMONO HADI NO 19 KUDUS 59319 029144400

1 PEMERINTAH DAERAH 440/327/23.01.01/2015

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

7 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

8 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

9 7-1601479543 RSUD RAA SOEWONDO PATI JL.DR. SUSANTO NO. 114 PATI 59163 DR. SUWORO NURCAHYONO.M.KES


26/01/2016 31/12/2016

10 7-1061786478RUMAH SAKIT KELUARGA SEHAT JL P SUDIRMAN NO 9 MARGOREJO PATI 59163 295386111 SWASTA

8784/KSH/PKS/XI/2015

RS.TRAUMA CENTRE 12/01/2016 01/09/2017

11 1500000000137RUMAH SAKIT KUMALASIWI KUDUS

JL JEPARA KM 6 DESA MIJEN RT 10 RW 06 KALIWUNGU 4245551

RUMAH SAKIT KUMALASIWI KUDUS PER/005/2016

RS.TRAUMA CENTRE 02/02/2016 31/12/2017

12 7-1534312103RUMAH SAKIT MARDI RAHAYU KUDUS

JL AKBP R AGIL KUSUMADYA KUDUS 59346DR KHRISNA NUGRAHA W


21/01/2016 31/12/2016

13 7-1534989054 RUMAH SAKIT UMUM DAERAH KELET

JL RAYA KELET KM 33 JEPARA 59431 DR WIDYO KUNTO M.KESMRS

PER/0035/112015

RS.TRAUMA CENTRE

21/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


66 / 10802-03-201613:40:34


KANTOR CABANG : L06- KANTOR CABANG MAGELANG


IKS


1 7-1712506763 RSUD DR TJITROWARDOJO PURWOREJO

JL. JENDERAL SUDIRMAN NO. 60 PURWOREJO

54114 275321118RSUD DR TJITROWARDOJO PURWOREJO


29/01/2016 31/12/2017

2 1500000000113 RUMAH SAKIT ISLAM WONOSOBO

JL MAYJEN BAMBANG SUGENG KM 03 MENDOLO BUMIRESO 322961

YAYASAN AMAL DAN KESEJAHTERAAN UMAT ISLAM (YAKAUMI)


3 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 81JL KS TUBUN NO 81 RT 01/01 KEL DEBONGTENGAH

0818289836

DR SUHARJO PER/10/2015RS.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 7-2131470963 KLINIK 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/13/2015

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


Periode : 01012016 s/d 31122016


67 / 10802-03-201613:40:34



IKS


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

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 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

11 01626 RSU KARDINAH TEGAL JL KS TUBUN NO. 1 TEGAL PER/14/2015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

12 0900000000035RSUD DR SOESELO SLAWI (TC) JL DR SUTOMO NO 63 SLAWI 491991

DR WIDODO JOKO MULYONO, M,KES,MMR PER/04/2015

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

13 1500000001236 RSUD SURADADI JL RAYA TEGAL-PEMALANG KM.12 SURADADI

3336263 PEMERINTAH KABUPATEN TEGAL


01/01/2016 31/12/2016

14 0900000000029 RSUI HARAPAN ANDA (TC) JL ABABIL NO 42 353387 HABIYAH. MMR PER/03/2015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

KANTOR CABANG : L08- KANTOR CABANG KLATEN


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


Periode : 01012016 s/d 31122016


68 / 10802-03-201613:40:34



IKS


2 7-1549815415 KLINIK NAYAKA HUSADA 02BOYOLALI DK. BUTUH MOJOSONGO BOYOLALI 57322 024760562

1

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 1500000000083KLINIK 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

5 0800000000001 RSI KLATEN JL YOGYA-SOLO KETANDAN KLATEN PER/01/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

6 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

7 0800000000004RSU PANDAN ARANG BOYOLALI JL KANTIL 14 BOYOLALI PER/02/012016

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

8 0800000000002 RSU SOERADJI TIRTONEGORO

JL SURADJI TIRTONEGORO PER/04/012016 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

9 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/001/012016 RS.TRAUMA CENTRE

21/01/2016 31/12/2017


Periode : 01012016 s/d 31122016


69 / 10802-03-201613:40:34


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 PER/06/012016 RS.TRAUMA CENTRE 13/01/2016 31/12/2016

3 1500000001574 KLINIK PRATAMA "MANUNGGAL" JL ARGO BUSONO NO.1 322480 KOPERASI PT DAMATEX PER/08/012016 RS.TRAUMA

CENTRE 25/02/2016 31/12/2016

4 1400000000656 KLINIK 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 AMBARAWA JL JENDRAL SUDIRMAN NO 76 KEC AMBARAWA KAB SEMARANG

50611 DINAS 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 PER/07/012016 RS.TRAUMA CENTRE 15/02/2016 31/12/2016

7 7-2008215164 PUSKESMAS BANYUBIRUJL 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 591539DINAS KESEHATAN KAB.SEMARANG


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

50218 DINAS KESEHATAN KAB SEMARANG


15/02/2016 31/12/2016

11 7-1990357685 PUSKESMAS DADAPAYAM JL RAYA DADAPAYAM NO.79, KEC SURUH 5018602987108802

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


Periode : 01012016 s/d 31122016


70 / 10802-03-201613:40:34



IKS


13 7-2006436553 PUSKESMAS GEDANGAN JL RAYA SALATIGA MUNCUL KM 3 KEC TUNTANG KAB SEMARANG 50131 024692123

8 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 PER/07/012016 RS.TRAUMA CENTRE 12/02/2016 31/12/2016

15 1500000000337 PUSKESMAS JAMBU JL. RAYA SEMARANG MAGELANG KM 4 KEC.JAMBU

593532 DINAS KESEHATAN KAB.SEMARANG


12/02/2016 31/12/2016

16 7-1989943593 PUSKESMAS JETAK DS.JETAK , KEC.GETASAN 50774 0298314664

DINKES KAB SEMARANG PER/07/012016 RS.TRAUMA CENTRE

12/02/2016 31/12/2016

17 7-2008732846 PUSKESMAS JIMBARAN JL TEGAL PANAS JIMBARAN KEC BAWEN KAB SEMARANG 50661 DINAS KESEHATAN KAB

SEMARANG PER/07/012016 RS.TRAUMA CENTRE 15/02/2016 31/12/2016

18 7-1990221924 PUSKESMAS KALIWUNGU JL AMPEL SIMO 186, KEC.KALIWUNGU 5022102763331213 DINKES KAB SEMARANG PER/07/012016

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

19 7-2009520872 PUSKESMAS KALONGAN JL ARJUNA NO 2 KE UNGARAN TIMUR KAB SEMARANG



15/02/2016 31/12/2016

20 7-2009063660 PUSKESMAS LEREP JL YUDISTIRA RAYA KM 3 KEC UNGARAN TIMUR KAB SEMARANG



15/02/2016 31/12/2016

21 7-2009405851 PUSKESMAS LEYANGANJL PUSKESMAS NO 1 KEC UNGARAN BARATKAB SEMARANG 50512


RS.TRAUMA CENTRE 15/02/2016 31/12/2016

22 7-1990444836 PUSKESMAS PABELAN JL PEMUDA NO.98 PABELAN, KEC,PABELAN 507710298321124

DINAS KESEHATAN KAB.SEMARANG PER/07/012016

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

23 1500000000339 PUSKESMAS PRINGAPUS JL.HONGOWICONO NO.5 KEC. PRINGAPUS 25721150DNIAS KESEHATAN KAB.SEMARANG


12/02/2016 31/12/2016

24 7-1990583417 PUSKESMAS SEMOWO DS SEMOWO , KEC. PABELAN 50771 02987100985

DINAS KESEHATAN KAB.SEMARANG


12/02/2016 31/12/2016


Periode : 01012016 s/d 31122016


71 / 10802-03-201613:40:34



IKS


25 1500000000336 PUSKESMAS SUMOWONO JL.PAHLAWAN NO.15 KEC SUMOWONO 40575050 DINAS KESEHATAN KAB.SEMARANG PER/07/012016 RS.TRAUMA

CENTRE 12/02/2016 31/12/2016

26 1500000000343 PUSKESMAS SURUH JL RAYA SURUH PLUMBON KEC SURUH 2882262 DINAS KESEHATAN KAB.SEMARANG PER/07/012016 RS.TRAUMA

CENTRE 12/02/2016 31/12/2016

27 1500000000342 PUSKESMAS SUSUKAN JL RAYA SUSUKAN NO.96 KEC SUSUKAN 615066 DINAS KESEHATAN KAB SEMARANG


12/02/2016 31/12/2016

28 1500000000344 PUSKESMAS TENGARAN JL RAYA SALATIGA SOLO KM 9 KEC. TENGARAN

DINAS KESEHATAN KAB.SEMARANG


12/02/2016 31/12/2016

29 7-1990928198 PUSKESMAS TUNTANG JL FATMAWATI NO.47, KEC TUNTANG 50131 0298340007

DINAS KESEHATAN KAB.SEMARANG PER/07/012016 RS.TRAUMA

CENTRE 12/02/2016 31/12/2016

30 7-2009013889 PUSKESMAS UNGARANJL AHMAD YANI NO 2-3 KEC UNGARAN KAB SEMARANG 50511


RS.TRAUMA CENTRE 15/02/2016 31/12/2016

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/03/012016RS.TRAUMA CENTRE 12/01/2016 31/12/2016

34 01728 RSUD SALATIGA JL OSAMALIKI NO 19 SALATIGA 324074 KOTA MAGELANG PER/03/012016RS.TRAUMA CENTRE 12/01/2016 31/12/2016

35 1400000000018 RSUD UNGARAN JL DIPONEGORO NO. 125 UNGARAN 6921006 PEMDA KAB.SEMARANG PER/01/012016RS.TRAUMA CENTRE

12/01/2016 31/12/2016

KANTOR CABANG : L11- KANTOR CABANG SEMARANG KALIGAWE


Periode : 01012016 s/d 31122016


72 / 10802-03-201613:40:34



IKS


1 1500000001891 KLINIK 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 SEJATI DS KARANGSARI RT 01/04 KARANGTENGAHDEMAK

089671458335

NINDYA ANGGI SINANTARA PER/09/012016 RS.TRAUMA

CENTRE 11/01/2016 31/12/2016

3 1500000001534 KLINIK PRATAMA DWI PUSPITA KALIGAWE

JL. RAYA KALIGAWE KM 7 NO 9 TRIMULYOSEMARANG

082180099759

HJ. ANISFA BAKAR PER/12/012016 RS.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

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 1400000000261KLINIK 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 1500000001807KLINIK 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 1500000001333KLINIK PRATAMA SEHAT UTAMA

JL. MEDOHO RAYA NO 21 SAMBIREJO SEMARANG

6719222HJ. 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


Periode : 01012016 s/d 31122016


73 / 10802-03-201613:40:34



IKS


13 1100000000006 RS 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 1300000000033 RS 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 1400000000402 RSUD SUNAN KALIJAGA (RSTC)

JL. SULTAN FATAH 669/50 DEMAK 685018 RSUD KAB. DEMAK PER/05/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

KANTOR CABANG : N00- KANTOR CABANG SURABAYA KARIMUNJAWA


IKS


1 1500000000715 ANUGERAH KARYA MEDIKACEMENGKALANG SIDOARJO

RUKO PURI INDAH BLOK 30,JATI-CEMENGKALANG-SIDOARJO

03171554259

SUSILO HENDROWARSITO


01/01/2016 31/12/2016

2 1500000000717 ANUGERAH KARYA MEDIKADEMAK

JL. DEMAK 375 SURABAYA 0811305143

CV. ANUGERAH KARYA MEDIKA


01/01/2016 31/12/2016

3 1500000000720ANUGERAH KARYA MEDIKAGUNUNGSARI JL. GUNUNGSARI NO.124 SURABAYA 5675589

CV. ANUGERAH KARYA MEDIKA PER/09/012016

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

4 1500000000712 BP 14JL. 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 5018800PT. NEURO SENTRA HUSADA


01/01/2016 31/12/2016

6 1500000001030 KLINIK 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


Periode : 01012016 s/d 31122016


74 / 10802-03-201613:40:34



IKS


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 PER/13/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

9 1500000001071 KLINIK KENCANA MEDIKA JL. KENDANGSARI NO. 78 SURABAYA 8498880 KLINIK KENCANA MEDIKA


01/01/2016 31/12/2016

10 1500000000716 KLINIK MEDIS AMBENGAN JL.AMBENGAN 35 SURABAYA 0818322119

CV. KARYA PUTRA AMBENGAN


01/01/2016 31/12/2016

11 1500000001072 KLINIK MEDPOINT JL. RAYA LONTAR 229 SURABAYA 7524067 KLINIK MEDPOINT PER/16/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

12 1500000001487KLINIK MODERN DASA MEDIKA JL. DIPONEGORO NO 161-163 SURABAYA 5677088

PT.PERKEBUNAN NUSANTARA X (PERSERO)


13 1400000000445 KLINIK NAYAKA HUSADA 15 JL RAYA KRIKILAN NO 259 DRIYOREJO GRESIK

7887273 PT NAYAKA ERA HUSADA


01/01/2016 31/12/2016

14 1400000000450 KLINIK NAYAKA HUSADA 24 JL RA KARTINI NO 236 C-9 KEBOMAS GRESIK

7887273 PT NAYAKA ERA HUSADA


01/01/2016 31/12/2016

15 1400000000449 KLINIK NAYAKA HUSADA 61RUKO SEPANJANG TOWN HOUSE C1-C3 JL KALIJATEN 7887273


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

16 1500000000713 KLINIK PRATAMA 65 JL. GUBENG KERTAJAYA X1/38 SURABAYA08883535666

DR ADRIANUS MICHAEL FOEH PER/18/012016

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

17 1500000000718KLINIK PRATAMA ALAMANDA

JL. DINOYO NO.20-II 5677767 CV. INTI PRATAMA PER/17/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

18 1500000000718 KLINIK PRATAMA ALAMANDA

JL. DINOYO NO.20-II 5677767 CV. INTI PRATAMA PER/19/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


75 / 10802-03-201613:40:34



IKS


19 1400000000443 KLINIK PRATAMA NAYAKA 02 JL MASTRIP NO 150 KEBRAON SURABAYA 7887273 PT NAYAKA ERA


20 1400000000439 KLINIK PRATAMA NAYAKA HUSADA 01 JL CENDRAWASIH NO 28B 7887273 PT NAYAKA ERA



JL ASEM ROWO KALI NO 1 7887273 PT NAYAKA ERA HUSADA


01/01/2016 31/12/2016


JL PANDEGILING NO 117A 7887273 PT NAYAKA ERA HUSADA


01/01/2016 31/12/2016

23 1400000000448 KLINIK PRATAMA NAYAKA HUSADA 07 JL TANDES ASRI NO 64 7887273 PT NAYAKA ERA


24 1400000000451KLINIK PRATAMA NAYAKA HUSADA 42 JL KALI RUNGKUT NO 52 7887273


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

25 1500000001483 KLINIK PRATAMA PG KREMBOONG

DESA KREMBOONG SIDOARJO 081332074648

PTPN X PER/24/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

26 1500000001483 KLINIK PRATAMA PG KREMBOONG

DESA KREMBOONG SIDOARJO 081332074648


01/01/2016 31/12/2016

27 1500000001484KLINIK PRATAMA PG TOELANGAN DESA TULANGAN SIDOARJO PTPN X PER/24/012016

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

28 1500000001484KLINIK PRATAMA PG TOELANGAN DESA TULANGAN SIDOARJO PTPN X PER/06/012016

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

29 1500000001485KLINIK PRATAMA PG WATOETOELIS

DESA TEMU KECAMATAN PRAMBON SIDOARJO

081332074648

PTPN X PER/06/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

30 1500000001485 KLINIK PRATAMA PG WATOETOELIS

DESA TEMU KECAMATAN PRAMBON SIDOARJO

081332074648


01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


76 / 10802-03-201613:40:34



IKS


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 PER/21/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

33 1500000000478 RS BHAKTI DHARMA HUSADA

JL RAYA KENDUNG NO 115-117 7404444 PEMERINTAH KOTA SURABAYA


01/01/2016 31/12/2016

34 0700000000013 RS BHAYANGKARA HS SAMSOERI M

JL. A YANI NO. 116 SURABAYA 8292227 POLDA JATIM PER/01/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

35 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

36 1500000001385 RS MATA UNDAAN JL UNDAAN KULON 17-19 SURABAYA 5343806 RS MATA UNDAAN PER/22/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

37 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

38 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

39 1500000001384RS UNIVERSITAS AIRLANGGA

KAMPUS C MULYOREJO UNIVERSITAS AIRLANGGA SBY 8439473

UNIVERSITAS AIRLANGGA PER/08/012016

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

40 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

41 1400000000360RUMAH SAKIT SURABAYA MEDICAL SERVICE

JL. KAPUAS NO.2 SURABAYA 5686161 YAYASAN PUJA HUSADA PER/23/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

KANTOR CABANG : N01- KANTOR CABANG KEDIRI


Periode : 01012016 s/d 31122016


77 / 10802-03-201613:40:34



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 : 01012016 s/d 31122016


78 / 10802-03-201613:40:34



IKS


1 1300000000016 RS. BAPTIS BATU JL. RAYA TLEKUNG NO.1 JUNREJO 594161 YAYASAN BAPTIS INDONESIA PER/01/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

2 1200000000012 RS. BHAYANGKARA HASTA BRATA JL. RA KARTINI NO. 01 597023 PER/03/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

3 1200000000008 RS. WAVA HUSADA JL. PANGLIMA SUDIRMAN NO. 99 A DILEM KEPANJEN

393000 ABNASAMANHUDI SAUTIKA HUSADA PT


01/01/2016 31/12/2016

4 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

5 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

6 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

7 1200000000010 RSU. PRASETYA HUSADA JL. RAYA NGIJO NO. 25 KARANG PLOSO 460558 SUJIATI, SST,MM.KES PER/08/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

8 1000000000011 RUMAH SAKIT MARSUDI WALUYO

JL.RAYA MONDOROKO KM 9 SINGOSARI MALANG

458919 DR.KRISTIWI HANGGRIYANI


01/01/2016 31/12/2016

9 1000000000011RUMAH SAKIT MARSUDI WALUYO

JL.RAYA MONDOROKO KM 9 SINGOSARI MALANG 458919

DR.KRISTIWI HANGGRIYANI PER/06/012016

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

10 1000000000013RUMAH 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

11 1000000000012RUMAH SAKIT PRIMA HUSADA

JL.BANJARARUM SELATAN NO 3 MONDOROKO-SINGOSARI MALANG

458679 DR.SADI HARIONO PER/09/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

12 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


Periode : 01012016 s/d 31122016


79 / 10802-03-201613:40:34



IKS


13 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

14 1400000000001RUMAH SAKIT UMUM DAERAH DR. SAIFUL ANWAR

JL. JAKSA AGUNG SUPRAPTO 362101 PEMPROV JATIM PER/10/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

15 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

16 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

2 7-1672273183 RS CITRA HUSADAJL. TERATAI NO. 22 DS. GEBANG KEC. PATRANG KOTA JEMBER 68117

0331486200

YAYASAN CITRA HUSADA PER/004/012016

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

3 7-1672273183 RS CITRA HUSADAJL. TERATAI NO. 22 DS. GEBANG KEC. PATRANG KOTA JEMBER 68117

0331486200

YAYASAN CITRA HUSADA PER/4/012016

RS.TRAUMA CENTRE 01/02/2016 31/12/2016

4 1400000000626 RS ISLAM LUMAJANG JL KYAI MUKSIN 19 LUMAJANG 887999DR R ELYUNAR DWI NUGROHO


01/01/2016 31/12/2016

5 7-1692033973 RS JEMBER KLINIK JALAN BEDADUNG NO.2 JEMBER LOR PATRANG JEMBER

68111 0331487104

PT NUSANTARA MEDIKAUTAMA


28/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


80 / 10802-03-201613:40:34



IKS


6 1400000000009 RSU KALIWATES JEMBER JL DIAH PITALOKA NO 4 A JEMBER 485967 PT ROLAS NUSANTARA MEDIKA PER/21/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

7 7-1938064553 RSUD DR HARYOTO KAB LUMAJANG JL BASUKI RAHMAD NO 5 LUMAJANG 67311 033488166

6 PEMPROV PER/007/022016 RS.TRAUMA CENTRE 22/02/2016 31/12/2016

KANTOR CABANG : N04- KANTOR CABANG PASURUAN


IKS


1 1500000001062 BP JAMSOSTEK 22JL. PUCANGSARI, SENGONAGUNG, PURWOSARI 7764043 CV CITRA MEDIKA IKS/09/012016

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

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/15/012016RS.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/14/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

6 1500000001338 KLINIK CITRA PURWOSARI JL. RAYA PURWOSARI NO. 21, 612244 CV CITRA MEDIKA IKS/13/012016RS.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/12/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


81 / 10802-03-201613:40:34



IKS


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/07/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

11 1500000001043 KLINIK MITRA 95 JL. STADION 28 PANDAAN / JL. PATTIMURA 636028 CV MITRA HUSADA IKS/06/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

12 1500000001052 KLINIK RAWAT INAP ISLAM AISYIYAH

JL. PAHLAWAN SUNARYO 257, KUTOREJO, PANDAAN 637367 IKS/04/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

13 1500000001233 RS RIZANI HUSADA JL. RAYA KOTAANYAR NO. 42 773444 PT RIZANI HUSADA IKS/16/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

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/48/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


82 / 10802-03-201613:40:34



IKS


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 61352 CV BANGUN SESAMA DAMAI SEJAHTERA


01/01/2016 31/12/2016

5 1400000000107 KLINIK INDUSTRI MEDIKA RUKO NGORO INDUSTRI PERSADA KAV A4-A6

61385 6817979 MARIA MEILITASARI HARLIN DR, SPPD, MARS


01/01/2016 31/12/2016

6 1500000001597 KLINIK KELUARGA BAHAGIA

JL RAYA BADUNG DSN BADUNG DS KEDUNGLENGKONG 61371 513355 NOVEL MOHAMMAD

RAMZY PUTRA PER/45/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

7 1500000001604 KLINIK MITRA 14 PERAKDSN GADING DS GADINGMANGU KEC PERAK 61461 DR WARTIK PER/51/122015

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

8 1500000001607 KLINIK MITRA 39 JL RAYA DIWEK NO 39 KEC DIWEK 61471 DR BETTY ENDAH WARNI MKES


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/52/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

11 1500000001599 KLINIK PRATAMA MITRA 38JL 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/50/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

13 1500000001595 KLINIK PRATAMA SURYA HUSADA 2

JL RAYA PRAMBON DS NGIMBANG MOJOSARI

61384 SITI NUR HIDAYATI ST MKES


01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


83 / 10802-03-201613:40:34



IKS


14 1500000001596 KLINIK SURYA HUSADA RAYA TRAWAS DSN WRINGINANOM DS MOJOREJO 61384 SITI NUR HIDAYATI ST

MKES PER/43/122015 RS.TRAUMA CENTRE 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 61311 0321328737

DR MAGDALENA SITORUS


01/01/2016 31/12/2016

17 1500000000353 RS GATOEL JL RADEN WIJAYA NO 56 KRANGGAN, PRAJURIT KULON

61319 328557 PT NUSANTARA MEDIKA UTAMA


01/01/2016 31/12/2016

18 1500000000927 RS KAMAR MEDIKA JL EMPUNALA NO 351 KEDUNDUNG MAGERSARI 330066 PT WAK KAMAR MEDIKA

HOSPITAL PER/65/122015 RS.TRAUMA CENTRE 20/01/2016 31/12/2016

19 1500000000925 RS MUTIARA HATIJL RAYA KEMANTREN WETAN NO 49 TERUSAN GEDEG 61351 363442 SULFAKAR DR SPOG PER/66/122015

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

20 1500000001594 RS NAHDLATUL ULAMA JOMBANG

JL KH HASYIM ASYARI NO 211 878700PT RUMAH SAKIT NAHDLATUL ULAMA JOMBANG


20/01/2016 31/12/2016

21 1500000001522 RS PELENGKAP MEDICAL CENTER

JL IR JUANDA NO 03 61411 877945 PT PELANGKAP MEDICA SEJAHTERA


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 PER/60/122015

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

23 0800000000034 RSI AROFAH (RS TC) JL. GAJAH MADA NO.1 MOJOSARI 61382 596900 DR HR SETIOHARTONO PER/62/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

24 1500000001523 RSI HASANAHJL HOS COKROAMINOTO NO 26-28 MOJOKERTO

321635PIMPINAN WILAYAH MUHAMMADIYAH JAWA TIMUR


20/01/2016 31/12/2016

25 1500000001621 RSI JOMBANG JL BRIGJEN KRETARTO NO 22 A 61411 860074

YAYASAN AMAL SHOLEH IKATAN PERSAUDARAAN HAJI INDONESIA


20/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


84 / 10802-03-201613:40:34



IKS


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 1500000000347 RUMAH SAKIT KRISTEN MOJOWARNO

JL MERDEKA NO 59 MOJOWARNO 61475 495093 YAYASAN KESEHATAN GKJW


01/01/2016 31/12/2016

KANTOR CABANG : N06- KANTOR CABANG BANYUWANGI


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 592890PIMPINAN CABANG MUHAMMADIYAH MUNCAR


01/01/2016 31/12/2016

3 7-1989906563RS NAHDLATUL ULAMA BANYUWANGI JL RAYA MANGIR NO 09 KEC ROGOJAMPI 68462 632965000

PC NAHDLATUL ULAMA KABUPATEN BANYUWANGI


4 1200000000005 RS YASMIN JL LETKOL ISTIQLAH 80-84 421198YAYASAN SUMBER WARAS PER/01/012016

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

5 1400000000010RSU BHAKTI HUSADA KRIKILAN

KRIKILAN GLENMORE 821118PT ROLAS NUSANTARA MEDIKA


01/01/2016 31/12/2016

6 1500000001552 RSUD ASEMBAGUS SITUBONDO

JL RAYA ASEMBAGUS KECAMATAN ASEMBAGUS


01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


85 / 10802-03-201613:40:34



IKS


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 1500000000826 RSUD GENTENG BANYUWANGI

JL HASANUDDIN NO 98 GENTENG 845839 PER/04/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

10 1500000001576 UPT PELATIHAN KERJA SITUBONDO

JL BASUKI RAHMAT NO 357 672054 PER/09/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

KANTOR CABANG : N08- KANTOR CABANG BLITAR


IKS


1 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

2 7-1575901783RSUD NGUDI WALUYO WLINGI JL DR SOECIPTO NO 5 66184

0342691006 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/01/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


86 / 10802-03-201613:40:34



IKS


2 1400000000437 RS LUKAS BANGKALAN JL KH MOCH KHOLIL 36A BANGKALAN 3095148 PHILIP PER/04/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

3 1400000000436 RSUD DR H MOH ANWAR SUMENEP JL DR CIPTO NO 42 SUMENEP 662494 PER/03/012016 RS.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

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

KANTOR CABANG : N11- KANTOR CABANG SIDOARJO


IKS


1 1500000001401 PUSKESMAS BALONGBENDO

JL MAYJEN BAMBANG SUWONO NO 11 SEDURI


01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


87 / 10802-03-201613:40:34



IKS


2 1500000001372 PUSKESMAS BARENGKRAJAN DS BARENGKRAJAN KEC KRIAN PER/26/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

3 1500000001363 PUSKESMAS BUDURAN JL JAWA NO 2 KEC BUDURAN PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

4 1500000001354 PUSKESMAS CANDI JL M RIDWAN NO 5 GELAM KEC CANDI PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

5 1500000001368 PUSKESMAS GANTING JL SINGO MENGGOLO NO 1 DS GANTING PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

6 1500000001367 PUSKESMAS GEDANGAN JL RAYA GEDANGAN 330 KEC GEDANGAN PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

7 1500000001352 PUSKESMAS JABON JL DUKUH SARI KEC JABON PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

8 1500000001346 PUSKESMAS KEDUNG SOLO DS KEDUNG SOLO KEC PORONG PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

9 1500000001356 PUSKESMAS KEPADANGAN DS KEPADANGAN KEC TULANGAN PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

10 1500000001344 PUSKESMAS KREMBUNG JL SUNGAI KAPUAS NO 2 KEC KREMBUNG PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

11 1500000001371 PUSKESMAS KRIAN JL SETIA BUDI KEC KRIAN PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

12 1500000001366 PUSKESMAS MEDAENG JL JOYOBOYO 40 MEDAENG KEC WARU PER/26/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

13 1500000001345 PUSKESMAS PORONG JL JUWET UTARA 265 KEC PORONG PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


88 / 10802-03-201613:40:34



IKS


14 1500000001343 PUSKESMAS PRAMBON JL RAYA PRAMBAON KEC PRAMBON PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

15 1500000001364 PUSKESMAS SEDATI DS BETRO KEC SEDATI PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

16 1500000001361 PUSKESMAS SEKARDANGAN

JL WIJAYA KUSUMA NO 91 SEKARDANGAN PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

17 1500000001359 PUSKESMAS SIDOARJO JL DR SOETOMO NO 14 KEC SIDOARJO PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

18 1500000001358 PUSKESMAS SUKODONO DS PEKARUNGAN KEC SUKODONO PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

19 1500000001369 PUSKESMAS TAMAN JL RAYA NGELOM 50 KEC TAMAN PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

20 1500000001353 PUSKESMAS TANGGULANGIN

JL RAYA PUTAT NO 38 KEC TANGGULANGIN


01/01/2016 31/12/2016

21 1500000001342 PUSKESMAS TARIK JL RAYA KEMUNING KEC TARIK PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

22 1500000001370 PUSKESMAS TROSOBO JL RAYA TROSOBO KEC TAMAN PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

23 1500000001355 PUSKESMAS TULANGAN JL RAYA KEMANTREN KEC TULANGAN PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

24 1500000001360 PUSKESMAS URANGAGUNG JL RAYA CEMENG KALANG KEC SIDOARJO PER/26/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

25 1500000001365 PUSKESMAS WARU JL BARITO POJOK NO 1 WISTROP KEC WARU


01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


89 / 10802-03-201613:40:34



IKS


26 1500000001357 PUSKESMAS WONOAYU JL WONOAYU KEC WONOAYU PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

27 1400000000128 RS BUNDA SIDOARJO JL KUNDI NO 70 KEPUH KIRIMAN WARU 8668880 PT PERMATA BUNDA BERSAMA PER/25/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

28 0800000000036 RS CITRA MEDIKA JL.RAYA SURABAYA-MOJOKERTO KM 44 361000 PER/21/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

29 1300000000030 RS SITI KHODIJAH JL PAHLAWAN NO 260 SEPANJANG 7882123 YYS MUHAMMADIYAH PER/23/12205 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

30 1400000000278 RSU ANWAR MEDIKA JL RAYA BY PASS KRIAN KM 33 BALONGBENDO 8974943 YAYASAN RUMAH SAKIT

ANWAR MEDIKA PER/22/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

31 1200000000014 RSU JASEM JL KH SAMANHUDI NO 85 8962129YAYASAN USADA KARYA PER/24/122015

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

32 0700000000008 RSUD SIDOARJO JL MAJAPAHIT NO 667 8961649 PER/20/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

KANTOR CABANG : N12- KANTOR CABANG GRESIK


IKS


1 1500000000811BP PANGLIMA SUDIRMAN GRESIK

JL PANGLIMA SUDIRMAN08563186435

YUNI HIDAYATI PER/12/012016RS.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


Periode : 01012016 s/d 31122016


90 / 10802-03-201613:40:34



IKS


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 PER/17/012016 RS.TRAUMA CENTRE 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 1500000001569 PUSKESMAS 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 1500000001492PUSKESMAS BUNGAH GRESIK JL RAYA BUNGAH 15 GRESIK 3949600

DRG TITY KARYATI PANIGORO PER/05/012016

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

9 1500000000757 PUSKESMAS CERME GRESIK JL RAYA CERME KIDUL 52 CERME 7990007 DR LESTARI PER/05/012015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

10 1500000001573 PUSKESMAS 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/05/012016

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

12 1500000000741PUSKESMAS DRIYOREJO GRESIK RAYA DRIYOREJO GRESIK 23264794 DR DANIEL SA'U PER/05/012016

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

13 1500000001571PUSKESMAS DUDUK SAMPEYAN GRESIK

RAYA DUDUK SAMPEYAN 45 DUDUK SAMPEYAN GRESIK

3903118 DRG NANIK LESTARI PER/05/012016RS.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


Periode : 01012016 s/d 31122016


91 / 10802-03-201613:40:34



IKS


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 PER/05/012016 RS.TRAUMA CENTRE 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 1500000000894 PUSKESMAS KEBOMAS GRESIK

JL SUNAN GIRI III/1 GRESIK 3985880 DR. RAHAJU NUGRAHANI


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 1500000001565PUSKESMAS KEPATIHAN GRESIK RAYA KEPATIHAN 151 7991403 DRG TITIEK SRI HAJATI PER/05/012016

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

21 1500000001566 PUSKESMAS KESAMBEN KULON GREIK

KESAMBEN KULON WRINGINANOM GRESIK

60438431 SIDIK NURDIJANTO, SKM PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

22 1500000001617 PUSKESMAS 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/05/012016

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

24 1500000001490PUSKESMAS MENTARAS GRESIK JL. RAYA MENTARAS DUKUN GRESIK 70954039 DR. RIZAUL FALAH PER/05/012016

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

25 1500000001568PUSKESMAS METATU GRESIK

JL. RAYA METATU 1 GRESIK 7991220 EKO HARIANTO, SKM PER/05/012016RS.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


Periode : 01012016 s/d 31122016


92 / 10802-03-201613:40:34



IKS


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 1500000001491 PUSKESMAS 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/05/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

33 1500000001562 PUSKESMAS UJUNG PANGKAH GRESIK

JL SITARDA 14 PANGKAH GRESIK 3944760 DR SETYORINI PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

34 1500000000889 PUSKESMAS 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 PER/08/012016

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

36 1500000000807RACHMIE CLINIC DUDUK SAMPEYAN

RUKO D RAYA REGENCY R1 DUDUK SAMPEYAN GRESIK 331284499

DR RAHMI ZUBAIDAH, SPMK PER/09/012016

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

37 1500000001983 RS FATHMA MEDIKA JL. PENDOPO 45 SEMBAYAT MANYAR 61111 3943500 DR. ASLUCHUL ALIF PER/15/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

38 0900000000039 RS PETRO KIMIA GRESIK JL JEND A YANI 69 3976688 DR.SINGGIH PRIYANTO, MARS


01/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


93 / 10802-03-201613:40:34



IKS


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/03/012016 RS.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/10/012016RS.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/06/012016RS.TRAUMA CENTRE 29/01/2016 31/12/2016

2 1500000001442 BP ASHABUL KAHFI JL MERBABU BLOK A NO.05 KEPUH PERMAI 8666334 CV KEMBANG TANJUNG PER/06/012016RS.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

20/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


94 / 10802-03-201613:40:34



IKS


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 20/01/2016 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

12/01/2016 31/12/2016

7 1500000001444 BP KEBANGKITAN JL MANUKAN MADYA 141 SURABAYA 71258886 CV KEMBANG TANJUNG PER/08/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

8 1500000001444 BP KEBANGKITAN JL MANUKAN MADYA 141 SURABAYA 71258886 CV KEMBANG TANJUNG PER/08/012016 RS.TRAUMA CENTRE 20/01/2016 31/12/2016

9 1500000001444 BP KEBANGKITAN JL MANUKAN MADYA 141 SURABAYA 71258886 CV KEMBANG TANJUNG PER/08/012016RS.TRAUMA CENTRE 01/02/2016 31/12/2016

10 1500000001443 BP KESAYANGAN JL RUNGKUT ASRI UTARA IV/10 (RL I/H-5) SURABAYA

8700691 CV KEMBANG TANJUNG PER/09/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

11 1500000001443 BP KESAYANGAN JL RUNGKUT ASRI UTARA IV/10 (RL I/H-5) SURABAYA


01/02/2016 31/12/2016

12 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

13 1500000001446 BP KESEJAHTERAANJL RUNGKUT MAPAN UTARA AA-17 SURABAYA 8706755 CV KEMBANG TANJUNG PER/10/012016

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

14 1500000001446 BP KESEJAHTERAANJL RUNGKUT MAPAN UTARA AA-17 SURABAYA

8706755 CV KEMBANG TANJUNG PER/10/012016RS.TRAUMA CENTRE

12/01/2016 31/12/2016

15 1500000001446 BP KESEJAHTERAAN JL RUNGKUT MAPAN UTARA AA-17 SURABAYA


01/02/2016 31/12/2016


Periode : 01012016 s/d 31122016


95 / 10802-03-201613:40:34



IKS


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 12/01/2016 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

20/01/2016 31/12/2016

19 1500000001393 KLINIK KARYA MEDIKA 104 JL BANYU URIP NO 302 SURABAYA 5324326 CV KARYA MEDIKA PER/16/012016 RS.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 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

22 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

23 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

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/18/012016RS.TRAUMA CENTRE 12/01/2016 31/12/2016

26 1500000001379 KLINIK SARTIKA 36BRATANG BINANGUN GANG VI/47 SURABAYA

34417343 DR LILIK SRI HARTINI PER/11/012016RS.TRAUMA CENTRE

01/02/2016 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


Periode : 01012016 s/d 31122016


96 / 10802-03-201613:40:34



IKS


28 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

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


12/01/2016 31/12/2016

31 1500000001377 KLINIK SARTIKA 44 JL RAYA MASTRIP NO 32 KARANG PILANG SURABAYA


01/02/2016 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/14/012016RS.TRAUMA CENTRE 12/01/2016 31/12/2016

34 1500000001373 POLIKLINIK PUTRI RAHAYU JL MASTRIP IX/9 WARUGUNUNG KARANGPILANG

7667983 BILAL ZAENAL ABIDIN PER/05/012016 RS.TRAUMA CENTRE

29/01/2016 31/12/2016

35 1500000001373 POLIKLINIK PUTRI RAHAYU JL MASTRIP IX/9 WARUGUNUNG KARANGPILANG

7667983 BILAL ZAENAL ABIDIN PER/05/012016 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

36 1500000001373 POLIKLINIK PUTRI RAHAYUJL MASTRIP IX/9 WARUGUNUNG KARANGPILANG 7667983 BILAL ZAENAL ABIDIN PER/05/012016

RS.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/03/012016RS.TRAUMA CENTRE 07/01/2016 31/12/2016

38 1100000000008 RS BUNDA SURABAYA JL RAYA KANDANGAN 23-24 7440077PT PERMATA BUNDA BERSAMA


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


Periode : 01012016 s/d 31122016


97 / 10802-03-201613:40:34



IKS


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 08/01/2016 31/12/2016

2 1400000000517 KLINIK WISMA HUSADA JL DUKUH SETRO 7A KAV NO 2 PER/ 01/ 012016RS.TRAUMA CENTRE 08/01/2016 31/12/2016

3 0700000000012 RS AL-IRSYAD JL KHM MANSUR 210-214 SURABAYA 3531223 DR AHMAD BAKARMAN, MARS

PER/ 02/012016 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

4 0700000000012 RS AL-IRSYAD JL KHM MANSUR 210-214 SURABAYA 3531223 DR AHMAD BAKARMAN, MARS

PER/ 02/012016 RS.TRAUMA CENTRE

13/01/2016 31/10/2016

5 1400000000469RUMAH SAKIT PRIMASATYAHUSADA CITRA JL. PRAPAT KURUNG SELATAN NO. 1 3294801

PT RUMAH SAKIT PRIMASATYA HUSADA CITRA

PER/ 03/ 012016RS.TRAUMA CENTRE 20/01/2016 31/12/2016

KANTOR CABANG : N15- KANTOR CABANG SURABAYA RUNGKUT


IKS


1 1100000000022 RS ISLAM SURABAYA JEMURSARI

JL JEMURSARI 51-57 60236 847187778 YAYASAN RS ISLAM SURABAYA


08/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


98 / 10802-03-201613:40:34


KANTOR CABANG : P00- KANTOR CABANG PONTIANAK


IKS


1 1400000000383 RSUD KABUPATEN SANGGAU

JL JENDRAL SUDIRMAN 21070 DR. H. EDY SUPRABOWO,MKM


24/02/2016 31/12/2016

2 1400000000464 RUMAH SAKIT UMUM BETHESDA SERUKAM JL. RAYA BENGKAYANG KM 48 SERUKAM 79281 637019 DR. EDY ARISTON LUBIS,

SPM., M.SC PER/11/022016 RS.TRAUMA CENTRE 24/02/2016 31/01/2017

KANTOR CABANG : R02- KANTOR CABANG KOTABARU


IKS


1 1500000000845 RUMAH 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 1300000000039 RSUD DR SOEMARNO SOSROADMODJO

JL TAMBUN BUNGAI NO 16 KAPUAS 23791 PEMKAB KAPUAS PER/13/062015 RS.TRAUMA CENTRE

02/03/2016 04/06/2017

2 7-2201647033UPT PUSKESMAS TANGKILING PALANGKARAYA

JL TJILIK RIWUT KM 34 KEL TANGKILING KEC BUKIT BATU 73221

UPT PUSKESMAS TANGKILING PER/04/012016

RS.TRAUMA CENTRE 24/02/2016 22/07/2016

KANTOR CABANG : R04- KANTOR CABANG PANGKALAN BUN


Periode : 01012016 s/d 31122016


99 / 10802-03-201613:40:34



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 : S01- KANTOR CABANG SAMARINDA


IKS


1 7-1380214421 PUKESMAS BANTUAS JL BANTUAS PALARAN 75241 PEMERINTAH PKS/02/12.2015RS.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/02/12.2015RS.TRAUMA CENTRE 11/01/2016 31/12/2016

5 7-1380408843 PUSKESMAS BUKUAN JL BUKUAN PALARAN 75241 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE 12/01/2016 31/12/2016

6 7-1464600433PUSKESMAS HARAPAN BARU

JL HARAPAN BARU SAMARINDA SEBERANG

75131 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE

20/01/2016 31/12/2016

7 7-1359826423 PUSKESMAS JUANDA JL IR JUANDA SAMARINDA ULU 75122 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

11/01/2016 31/12/2016


Periode : 01012016 s/d 31122016


100 / 10802-03-201613:40:34



IKS


8 7-1507208803 PUSKESMAS KARANG ASAMSAMARINDA JL KARANG ASAM 75125 PEMERINTAH PKS/02/12.2015 RS.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/02/12.2015 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

12 7-1464657234 PUSKESMAS MANGKUPALAS JL MANGKUPALAS SAMARINDA SEBERANG 75131 PEMERINTAH PKS/02/12.2015 RS.TRAUMA

CENTRE 20/01/2016 31/12/2016

13 7-1464111057 PUSKESMAS PALARAN JL PALARAN 75241 PEMERINTAH PKS/02/12.2015RS.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/02/12.2015RS.TRAUMA CENTRE 20/01/2016 31/12/2016

17 7-1461318105 PUSKESMAS SEGIRI JL SEGIRI SAMARINDA KOT 75111 PEMERINTAH PKS/02/12.2015RS.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


Periode : 01012016 s/d 31122016


101 / 10802-03-201613:40:34



IKS


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/02/12.2015 RS.TRAUMA CENTRE 12/01/2016 31/12/2016

22 7-1380635626 PUSKESMAS TEMINDUNG JL TEMINDUNG SAMARINDA UTARA 75118 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

23 7-1380777307 PUSKESMAS WONOREJO KELURAHAN WONOREJO 75125 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

24 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 : S04- KANTOR CABANG BERAU


IKS


1 7-1506142935PUSKESMAS GUNUNG TABUR

JL. BANGSAWAN RT 02 GUNUNG TABUR KAB. BERAU 77352

DINAS KESEHATAN KABUPATEN BERAU PER/06/122015

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

2 7-1507943081PUSKESMAS 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 SAMBALIUNGMANGKUBUMI II RT 007 SAMBALIUNG, KAB. BERAU

77371DINAS KESEHATAN KABUPATEN BERAU


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


Periode : 01012016 s/d 31122016


102 / 10802-03-201613:40:34


KANTOR CABANG : T00- KANTOR CABANG MANADO


IKS


1 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

2 02412 RS BUDI MULIA BITUNG JL YOS SUDARSO BITUNG 21332 DR. JOHANNIS ANDRIES NAJOAN MKES. SPFK.DK PER/22/10/2015 RS.TRAUMA

CENTRE 28/01/2016 31/12/2017

3 1400000000068 RS ROBERT WOLTER MONGISIDI JLN. 14 FEBRUARI TELING ATAS 876087 DR. ADHY SUGIH ARTO PER/007/03/2016 RS.TRAUMA

CENTRE 01/03/2016 31/12/2017

4 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

5 1400000000078 RSU PANCARAN KASIH GMIM MANADO

JL SAM RATULANGI XIII MANADO 857629 DR FRANKY V T KAMBEY


01/03/2016 31/12/2017

6 1500000000352 RUMAH SAKIT BHAYANGKARA MANADO JALAN SAM RATULANGI NO. 326 MANADO DRG. IGNATIUS HENDRA

ARIFIANTO PER/009/032016 RS.TRAUMA CENTRE 01/03/2016 31/12/2017

7 1500000000085RUMAH SAKIT BUDI MULIA BITUNG JL. SAM RATULANGI X/9A BITUNG LUCI PER/022/10/2015

RS.TRAUMA CENTRE 28/01/2016 31/12/2017

8 1400000000232RUMAH SAKIT UMUM BETHESDA

JALAN RAYA TOMOHON, KOTA TOMOHON 891020 DR ROBBIN R.F WAROUW PER/003/072016RS.TRAUMA CENTRE

01/03/2016 31/12/2017

9 1400000000153 RUMAH SAKIT UMUM HERMANA LEMBEAN

JLN. A. MONONUTU DESA LEMBEAN, MINAHASA UTARA

891020 DR. LAURENTIUS RONALD PONTOH


01/03/2016 31/12/2017

10 1400000000059 RUMKITAL DR. WAHYU SLAMET

JALAN YOS SUDARSO NO. 26 BITUNG 35030 DR. SUJOKO PURNOMO, SP.B


01/03/2016 31/12/2017

11 1400000000428SILOAM INTERNATIONAL HOSPITAL MANADO

JLN. SILOAM NO. 6 LIPPO VILLAGE TANGERANG

DR. ANDRY, M.M M.H.KES PER/23/112015

RS.TRAUMA CENTRE 28/01/2016 31/12/2017


Periode : 01012016 s/d 31122016


103 / 10802-03-201613:40:34


KANTOR CABANG : T01- KANTOR CABANG PALU


IKS


1 1400000000290 PUSKESMAS SALAKAN SALAKAN KABUPATEN BANGGAI KEPULAUAN

DR. JAMES HD PINONTOAN


14/01/2016 31/07/2016

2 1400000000054 RSD. MADANI JL. THALUAKOJI NO. 11 PALU 491470 PER/002/012016 RS.TRAUMA CENTRE 01/03/2016 28/02/2017

KANTOR CABANG : T02- KANTOR CABANG GORONTALO


IKS


1 1400000000104 RSUD M.M.DUNDA JLN 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

2 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

3 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

4 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

KANTOR CABANG : W00- KANTOR CABANG MAKASSAR


Periode : 01012016 s/d 31122016


104 / 10802-03-201613:40:34



IKS


1 1400000000044 RS AWAL BROS MAKASSAR JL. JENDRAL URIP SUMOHARJO NO. 43 454567 PT MAKASSAR GLOBAL AWAL BROS PER/006/012016 RS.TRAUMA

CENTRE 24/02/2016 31/12/2017

2 1500000000111 RSUP DR WAHIDIN SUDIROHUSODO MAKASSAR

JL PERINTIS KEMERDEKAAN KM 11 TAMALANREA PER/003/012016 RS.TRAUMA

CENTRE 01/03/2016 04/01/2018

KANTOR CABANG : W01- KANTOR CABANG KENDARI


IKS


1 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

2 1400000000062 RSUD ABUNAWAS KOTA KENDARI

JL BRIGJEN Z.A SUGIANTO NO.39 DINAS KESEHATAN KOTA KENDARI


22/02/2016 04/02/2017

3 1400000000381 RSUD KAB KOLAKA (BLUD) JL.WR SUPRATMAN NO 20 32213700 DINAS KESEHATAN KOLAKA


25/02/2016 08/02/2018

KANTOR CABANG : W02- KANTOR CABANG PALOPO


IKS


1 1500000000097 DR YAIN PANGGALO JL PONGTIKU RANTEPAO 255009811 DR YAIN PANGGALO PER/01/012016 RS.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


Periode : 01012016 s/d 31122016


105 / 10802-03-201613:40:34


KANTOR CABANG : W21- KABUPATEN SINJAI


IKS


1 7-2015740298 RSUD SINJAI JLN JEND SUDIRMAN NO. 47 SINJAI 92611 048221132 PEMERINTAH DAERAH KAB SINJAI


16/02/2016 03/01/2018

KANTOR CABANG : X00- KANTOR CABANG BALI DENPASAR


IKS


1 1400000000484 RS SURYA HUSADHA DENPASAR

JL PULAU SERANGAN NO 7 DENPASAR 233787 PER/02/012016 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

2 1400000000483 RS SURYA HUSADHA UBUNG JL COKROAMINOTO NO 356 PER/01/2016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

3 1200000000017RSU 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

4 1400000000554 RSU PARAMA SIDHI JLN. AHMAD YANI NO. 171A SINGARAJA 32701 PER/06/012016RS.TRAUMA CENTRE

08/01/2016 31/12/2016

5 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

6 1400000000485 SILOAM HOSPITAL BALI JALAN SUNSET ROAD NO 818 KUTA 779900 PER/04/012016 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

KANTOR CABANG : X01- KANTOR CABANG KUPANG


Periode : 01012016 s/d 31122016


106 / 10802-03-201613:40:34



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 1400000000288 RS BHAYANGKARA KUPANG JL NANGKA 84 KUPANG 85111 821999 POLRI / POLDA NTT PER/ 017/

102015RS.TRAUMA CENTRE 22/01/2016 31/12/2016

3 1400000000417 RSUD DR TC HILLERS MAUMERE

JALAN WAIRKLAU MAUMERE 2426133 PER/ 005/ 012016

RS.TRAUMA CENTRE

28/01/2016 31/12/2016

4 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

5 1400000000565 RSUD MGR GABRIEL MANEKATAMBUA JALAN DR SOETOMO NO 02 ATAMBUA 21016 PER/ 003/

012016RS.TRAUMA CENTRE 28/01/2016 31/12/2016

6 1400000000394RSUD UMBU RARA MEHA WAINGAPU JALAN ADAM MALIK NO 54 WAINGAPU 61302

PER/ 007/ 012016

RS.TRAUMA CENTRE 01/02/2016 30/01/2017

7 7-2240138189 RUMAH SAKIT KRISTEN LINDI MARA

JALAN PROF WZ YOHANNES NOMOR 06 87111 YUMERKRIS PER 010/ 022016 RS.TRAUMA CENTRE

24/02/2016 24/02/2017

8 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

9 1400000000543RUMAH SAKIT PENYANGGA PERBATASAN BETUN

JALAN SUKABIHANAWA DESA KAMANASAMALAKA TENGAH PER/ 09/ 022016

RS.TRAUMA CENTRE 15/02/2016 09/02/2017

10 7-1708103837SILOAM HOSPITALS LABUAN BAJO

JALAN GABRIEL GAMPUR RT 013 RW 005 DESA GORONTALO KECAMATAN KOMODO LABUAN BAJO

86754 PT LINTAS BUANA JAYAPER/ 006/ 012016

RS.TRAUMA CENTRE 29/01/2016 29/01/2017

KANTOR CABANG : X03- KANTOR CABANG MATARAM


Periode : 01012016 s/d 31122016


107 / 10802-03-201613:40:34



IKS


1 7-2053953083 RS H.L. MANAMBAI ABDULKADIR

JL LINTAS SUMBAWA-BIMA KM 5 KAB SUMBAWA BESAR 84311 803801361 DR H SYAMSUL

HIDAYAT PER/21/122015 RS.TRAUMA CENTRE 18/02/2016 31/12/2016

2 7-2305763363 RSUD 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

3 7-2043435163 RSUD KOTA MATARAM JALAN BUNG KARNO NO 3 PAGUTAN MATARAM

83117 907545167 DR H.L. HERMAN MAHAPUTRA MKES


01/01/2016 31/12/2016

4 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

5 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

6 7-2306934144 RSUD SUMBAWA JL GARUDA NO 5 SUMBAWA BESAR 84311 909048313 DR SELVI PER/04/012016RS.TRAUMA CENTRE 01/01/2016 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 1400000000473 RSUD KLUNGKUNG JL. FLAMBOYAN NO 40 SEMARAPURA 21172 PER/005/012016RS.TRAUMA CENTRE

22/01/2016 31/12/2016

3 1400000000321 RSUD SANJIWANI GIANYAR JL. CIUNG WANARA NO. 2 943049 PER/003/012016 RS.TRAUMA CENTRE

22/01/2016 31/12/2017


Periode : 01012016 s/d 31122016


108 / 10802-03-201613:40:34



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 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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