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DAFTAR JEJARING TRAUMA CENTER DAN FASILITAS KERJASAMABPJS KETENAGAKERJAAN

Periode : 01/01/2015 s/d 31/10/2016

Halaman : Tanggal Cetak : Waktu Cetak :

1 / 44607-11-201606:23:31

MA11222I DAFTAR JEJARING TRAUMA CENTER DAN FASILITAS KERJASAMA BPJS KETENAGAKERJAAN SM0480

KANTOR CABANG : 000- KANTOR CABANG AMBON

NO KODE PROVIDER NAMA PROVIDER ALAMAT KODEPOS TELEPON PIMPINAN

IKS

NO IKS TIPE IKS AWAL IKS AKHIR IKS

1 1500000000317 RS BERGERAK TIAKUR TIAKUR MALUKU BARAT DAYA 081343343290

KAB MALUKU BARAT DAYA

PER/004/032015 RS.TRAUMA CENTRE

01/04/2015 30/03/2016

2 7-4860099970 RS BERGERAK TIAKUR TIAKUR-MALUKU BARAT DAYA 97454 KAB MALUKU BARAT DAYA PER/004/032015 RS.TRAUMA

CENTRE 19/09/2016 31/03/2017

3 1500000000219 RS BHAYANGKARA POLDA MALUKU JL SULTAN HASANUDDIN , TANTUI 349450 POLDA MALUKU PER/001/022015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2017

4 1400000000084 RS HATI KUDUS LANGGUR JL. JEND. SUDIRMAN LANGGUR 21638 IDA RAHAIL, AKP. M.KES PER/012/042015 RS.TRAUMA CENTRE 01/04/2015 31/03/2017

5 1400000000056 RS HATIVE PASSO JL. LAKSDA LEO WATTIMENA AMBON 362512 YAYASAN SANTO LUKAS PER/008/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2017

6 7-141557413 RS TNI ANGKATAN LAUT DR. F.X. SOEHARDJO

JL LAYAR NO. 1 KOMPLEKS LANTAMAL IX AMBON 97231 091135254

7 DR . HISNINDARSYAH 001-000112015 RS.TRAUMA CENTRE 24/11/2015 31/10/2017

7 1400000000042RST TK II DR J.A. LATTUMETEN JL DR TAMAELA AMBON 353555 KODAM PATTIMURA PER/009/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2017

8 1400000000076 RSU AL FATAH AMBON JL SULTAN BAABULLAH AMBON 343848YAYASAN WAKAF AL FATAH

PER/013/042015RS.TRAUMA CENTRE

01/04/2015 31/03/2017

9 1400000000041 RSUD DR M HAULUSSY JL KAYADOE AMBON PEMDA PROV MALUKU PER/010/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2017

10 1500000000620 RSUD DR PP MAGRETTI JL. THEODORUS RESILOWY, SAUMLAKI PEMKAB MTB PER/007/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2017

11 1500000000818 RSUD NAMROLE JL KAMBOJA KAB BURU SELATAN PER/014/042015RS.TRAUMA CENTRE 01/04/2015 31/03/2017

12 1500000000539 RSUD PIRU JL ARTERI PIRUDR MICHEL A SIWABESSY PER/006/032015

RS.TRAUMA CENTRE 01/04/2015 31/03/2017


Periode : 01/01/2015 s/d 31/10/2016


2 / 44607-11-201606:23:31


KANTOR CABANG : 001- KANTOR CABANG TERNATE


IKS


1 1400000000043 DR. TUTHANURANII NACHRAWY, M. KES

JL. PAHLAWAN REVOLUSI DR.TUTHANURANI NACHRAWY


01/03/2015 28/02/2016

2 1400000000043 DR. TUTHANURANII NACHRAWY, M. KES JL. PAHLAWAN REVOLUSI DR.TUTHANURANI

NACHRAWY PER/004/032016 RS.TRAUMA CENTRE 31/03/2016 31/12/2018

3 1500000000215 RSU DHARMA IBU JL PAHLAWAN REVOLUSI NO 5 3121951 DR.SUTOMO RAHARJO, SP.A PER/002/022015 RS.TRAUMA

CENTRE 01/03/2015 31/12/2015

4 1500000000215 RSU DHARMA IBU JL PAHLAWAN REVOLUSI NO 5 3121951 DR.SUTOMO RAHARJO, SP.A PER/007/012016 RS.TRAUMA

CENTRE 27/07/2016 31/12/2018

5 1300000000005 RSUD CHASAN BOISOIRIE TERNATE

JL. TANAH TINGGI 3121281 PEMDA PER/001/022015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

6 1300000000005 RSUD CHASAN BOISOIRIE TERNATE JL. TANAH TINGGI 3121281 PEMDA PER/005/032016 RS.TRAUMA

CENTRE 24/05/2016 31/12/2018

7 1500000000625 RSUD JAILOLOJL RAYA ACANGO DESA ACANGO KEC JAILOLO PEMDA HALBAR PER/009/072016

RS.TRAUMA CENTRE 27/07/2016 31/12/2018

8 1500000000625 RSUD JAILOLOJL RAYA ACANGO DESA ACANGO KEC JAILOLO

PEMDA HALBAR PER/010/012015RS.TRAUMA CENTRE

01/05/2015 30/04/2016

9 05392 RSUD TOBELO JL. LANDBOUW TOBELO 21566 PEMKAB HALUT PER/07/0032015 FFS 01/04/2015 31/03/2016

10 05392 RSUD TOBELO JL. LANDBOUW TOBELO 21566 PEMKAB HALUT PER/007/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

11 08186RUMAH SAKIT DAERAH TIDORE KEPULAUAN JL. SULTAN MANSYUR INDONESIANA

PEMDA TIDORE KEPULAUAN PER/008/012016

RS.TRAUMA CENTRE 27/07/2016 31/12/2018

12 08186RUMAH SAKIT DAERAH TIDORE KEPULAUAN JL. SULTAN MANSYUR INDONESIANA

PEMDA TIDORE KEPULAUAN

01 MEI 2015 S.D30 APRIL 2016 FFS 01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


3 / 44607-11-201606:23:31



IKS


13 06574 RUMAH SAKIT ISLAM BINA WARGA TERNATE JLN.PEMUDA NO.131 KOTA TERNATE 3121623 YAYASAN ISLAM BINA

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

14 1500000000050 RUMAH SAKIT ISLAM TERNATE

JLN.PEMUDA NO.131 KELURAHAN TOBOLEU TERNATE 3121623 YAYASAN ISLAM BINA



JLN.PEMUDA NO.131 KELURAHAN TOBOLEU TERNATE

3121623 YAYASAN ISLAM BINA WARGA


13/07/2016 31/12/2016


JLN.PEMUDA NO.131 KELURAHAN TOBOLEU TERNATE

3121623 YAYASAN ISLAM BINA WARGA

PER/03/122014 FFS 01/01/2015 31/12/2015


JLN.PEMUDA NO.131 KELURAHAN TOBOLEU TERNATE 3121623 YAYASAN ISLAM BINA


18 1500000000035RUMAH 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

19 1500000000035 RUMAH SAKIT MEDIKA HARIFALM

KEL KOTA BARU KOTA TERNATE DR.AZIS MANAF SP.PD PER/004/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

20 1500000000036 RUMAH SAKIT TNI TK IV TERNATE

JL AIS NASUTION NO 2 TNI PER/009/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

21 1500000000036RUMAH SAKIT TNI TK IV TERNATE JL AIS NASUTION NO 2 TNI PER/006/012016

RS.TRAUMA CENTRE 21/06/2016 31/12/2016

22 1500000000296RUMAH SAKIT UMUM DAERA WEDA JL RAYA WEDA PEMDA HALTENG PER/010/102016

RS.TRAUMA CENTRE 06/10/2016 31/12/2018

23 1500000000296RUMAH SAKIT UMUM DAERA WEDA

JL RAYA WEDA PEMDA HALTENG PER/006/032015RS.TRAUMA CENTRE

01/04/2015 31/03/2016

24 08016 RUMAH SAKIT UMUM DAERAH LABUHA

JL. RAYA LABUHA BABANG 21118 HJ. AISA BADARUNI S.KM, M.KES


14/03/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


4 / 44607-11-201606:23:31



IKS


25 1500000000295 RUMAH SAKIT UMUM DAERAH MABA

JL TRANS HALMAHERA KEC KOTA MABA HALMAHERA TIMUR

PEMDA HALMAHERA TIMUR PER/005/032015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

KANTOR CABANG : 003- KOTA TUAL


IKS


1 7-4662730223 RSUD CENDRAWASIH DOBO JL. CENDRAWASIH KM.6 DOBO, 97662 91721366 DR. HENTJI HENDRIK DARAKAY PER/08/062016 RS.TRAUMA

CENTRE 08/09/2016 08/06/2018

2 7-3193917369RSUD KAREL SATSUITUBUN LANGGUR

JL. MERDEKA RAYA NO. 03 OHOIJANG LANGGUR 97611

21612/21613

DR. K. NOTANUBUN, M. KES

199/631/RSUD/KS/V/2016

RS.TRAUMA CENTRE 09/05/2016 06/04/2018

KANTOR CABANG : 100- KANTOR CABANG SORONG


IKS


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

YULIANTI MATANDUNG,S.SOS,MM PER/37/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

2 1500000000503BALAI LATIHAN KERJA INDUSTRI (BLKI) SORONG

JL BASUKI RAHMAT KM 9.5 KOTA SORONG 322549YULIANTI MATANDUNG,S.SOS,MM


25/04/2016 31/03/2017

3 7-136050403 KLINIK DUMMY JL. JALAN 98414 ALI KHAIDHIR 11111111 RS.TRAUMA CENTRE

21/10/2015 31/12/2017

4 1400000000012 KLINIK MAJU BERSAMA (KLINIK-TC)

JL BASUKI RAHMAT KM 11 (DEPAN BATALION)

DR LIDIA KURNIAWAN PER/018/032015 RS.TRAUMA CENTRE

01/03/2015 28/02/2016


Periode : 01/01/2015 s/d 31/10/2016


5 / 44607-11-201606:23:31



IKS


5 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

6 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

7 1500000000384 PUSKESAMAS SAYOSA SAYOSA KAB SORONG 48060504 PER/031/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2017

8 1500000000383 PUSKESMAS BERAUR (KTC) BERARUR KAB SORONG 54285228 PER/032/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2017

9 1500000000434 PUSKESMAS KLABOT (KTC) KLABOT KABUPATEN SORONG 54173183 PER/030/032015 RS.TRAUMA CENTRE 01/04/2015 31/03/2017

10 1500000000435PUSKESMAS KLAFDALIM (KTC) KLASARI KAB SORONG 54173183 PER/023/032015

RS.TRAUMA CENTRE 01/04/2015 31/03/2017

11 1500000000386 PUSKESMAS KLAMONO (KTC)

JL KLAWANA DISTRIK KLAMONO 1060944 PER/028/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2017

12 1500000000382 PUSKESMAS KLASOUW (KTC)

KLASOUW KAB SORONG 44468629 PER/0034/032015

RS.TRAUMA CENTRE

01/04/2015 31/03/2017

13 1500000000376 PUSKESMAS KLAWAK (KTC) KLAWAK KAB SORONG 62003121 PER/033/032015RS.TRAUMA CENTRE 01/04/2015 31/03/2017

14 1500000000380 PUSKESMAS KLAYILI (KTC) KLAYILI KAB SORONG 47330915 PER/036/032015RS.TRAUMA CENTRE 01/04/2015 31/03/2017

15 1500000000390PUSKESMAS MAJARAN (KTC)

MAJARAN MARIYAI SP 2 44086493 PER/021/032015RS.TRAUMA CENTRE

01/04/2015 31/03/2017

16 1500000000388 PUSKESMAS MAKBON (KTC) MAKBON KAB SORONG 99373405 PER/024/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2017


Periode : 01/01/2015 s/d 31/10/2016


6 / 44607-11-201606:23:31



IKS


17 1500000000391 PUSKESMAS MALAWILI JL NANGKA KELURAHAN AIMAS KAB SORONG 44181510 PER/019/032015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2017

18 1500000000379 PUSKESMAS MARIAT (KTC) MARIYAI SP 2 39495966 PER/ 020/032015 RS.TRAUMA CENTRE 01/04/2015 31/03/2017

19 1500000000378 PUSKESMAS MARIAT (KTC) MARIYAI SP 2 39495966 PER/020/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2017

20 1500000000381 PUSKESMAS MAUDUS (KTC) MAUDUS KAB SORONG 54691544 PER/035/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2017

21 1500000000389 PUSKESMAS MAYAMUK (KTC)

JL POROS KELURAHAN MAKBALIM KAB SORONG 44419198 PER/022/032015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2017

22 1500000000385 PUSKESMAS MEGA MEGA KAB SORONG 97935870 PER/029/032015RS.TRAUMA CENTRE 01/04/2015 31/03/2017

23 1500000000387 PUSKESMAS SAILOLOF SALAWATI SELATAN KABUPATEN SORONG 19764619 PER/027/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2017

24 1500000000436 PUSKESMAS SEGET (KTC) SEGET KAB SORONG 44070654 PER/025/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2017

25 1500000000377 PUSKESMAS SEGUN (KTC) SEGUN KAB SORONG 3199503 PER/026/032015RS.TRAUMA CENTRE 01/04/2015 31/03/2017

26 1500000000592 RS HERLINA (RSTC) JL SELAT MAKASSAR NO 7 4852341 IR HERLINA SIHOMBING PER/040/052015RS.TRAUMA CENTRE 01/05/2015 30/04/2016

27 1500000000104RS MUTIARA SORONG (RSTC)

JL MALEO NO 2 KOTA SORONG 327433DR HJ PAHIMA ISKANDAR


01/01/2015 31/12/2015

28 1500000000104 RS MUTIARA SORONG (RSTC)

JL MALEO NO 2 KOTA SORONG 327433 DR HJ PAHIMA ISKANDAR


01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


7 / 44607-11-201606:23:31



IKS


29 1500000000551 RS PERTAMINA SORONG (RSTC) JL A YANI NO 13 SORONG PAPUA BARAT 44440220 PER/039/042015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

30 1400000000567 RSAL DR AZHAR ZAHIR MANOKWARI (RSTC) JLN SERMA SUWANDI MANOKWARI 211758 MABES TNI AL PER/006/022016 RS.TRAUMA

CENTRE 07/03/2016 31/01/2017

31 1400000000022 RSAL DR OETOYO (RS TC) JLN JEND AHMAD YANI PER/002/032016 RS.TRAUMA CENTRE

27/04/2016 28/02/2017

32 1400000000022 RSAL DR OETOYO (RS TC) JLN JEND AHMAD YANI PER/038/032015 RS.TRAUMA CENTRE

01/03/2015 28/02/2016

33 1400000000539 RSUD KAB FAK-FAK (RSTC) JL. JENDRAL SUDIRMAN KAB FAK-FAK 44671705 PER/02/122015 RS.TRAUMA CENTRE 12/05/2016 30/11/2016

34 1400000000408RSUD KAB RAJA AMPAT (RSTC) JL DISTRIK WAISAI 44717931 PER/043/112015

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

35 1400000000034 RSUD KAB SORONG (RSTC) JL KESEHATAN NO 36 321763 PER/004/042016 RS.TRAUMA CENTRE

08/04/2016 31/03/2017

36 1400000000034 RSUD KAB SORONG (RSTC) JL KESEHATAN NO 36 321763 PER/41/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

37 1400000000457 RSUD MANOKWARI (RSTC) JL BHAYANGKARA NO 1 MANOKWARI 44110391 PER/007/112015RS.TRAUMA CENTRE 07/03/2016 31/10/2016

38 1400000000457 RSUD MANOKWARI (RSTC) JL BHAYANGKARA NO 1 MANOKWARI 44110391 PER/010/112014RS.TRAUMA CENTRE 07/03/2016 31/10/2015

39 1500000000080RSUD SCHOLOO KEYEN SORSEL (RSTC)

JLN TEMINABUAN AYAMARU KP KEYEN 7705545PEMDA SORONG SELATAN


01/01/2015 31/12/2016

40 1500000000101 RSUD SELE BE SOLU KOTA SORONG (RSTC)

JLN BASUKI RAHMAT KM 12 SORONG 8460538 PEMKOT KOTA SORONG PER/009/062016 RS.TRAUMA CENTRE

01/06/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


8 / 44607-11-201606:23:31



IKS


41 1500000000101 RSUD SELE BE SOLU KOTA SORONG (RSTC) JLN BASUKI RAHMAT KM 12 SORONG 8460538 PEMKOT KOTA SORONG PER/042/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

42 02442 RSUD SORONG JL YOS SUDARSO SORONG 321580 PER/004/042016 RS.TRAUMA CENTRE 01/04/2016 31/03/2017

KANTOR CABANG : 101- KANTOR CABANG JAYAPURA


IKS


1 1500000000501BLK INDUSTRI PROVINSI PAPUA JL. PASIFIK INDAH I BASE G JAYAPURA

BLK. INDUSTRI PROV. PAPUA PER/11/032015

RS.TRAUMA CENTRE 18/03/2015 17/03/2016

2 1500000000501 BLK INDUSTRI PROVINSI PAPUA

JL. PASIFIK INDAH I BASE G JAYAPURA BLK. INDUSTRI PROV. PAPUA


25/05/2016 31/12/2017

3 1500000000457 KLINIK PRATAMA BUNDA HATI KUDUS

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


13/04/2016 31/12/2017

4 1500000000457KLINIK PRATAMA BUNDA HATI KUDUS JL. RAYA MANDALA NO. 26 MERAUKE 44603533

KLINIK PRATAMA BUNDA HATI KUDUS PER/10/0315

RS.TRAUMA CENTRE 18/03/2015 17/03/2016

5 7-5186520298 PUSKESMAS ABE PANTAI JL ABE PANTAI, DISTRIK ABEPURA 99221 PUSKESMAS ABE PANTAI PER/09/102016RS.TRAUMA CENTRE 17/10/2016 31/12/2017

6 7-5186519675 PUSKESMAS ABEPURA JL. RAYA SENTANI, DISTRIK ABEPURA 99221 PUSKESMAS ABEPURA PER/09/102016RS.TRAUMA CENTRE

17/10/2016 31/12/2017

7 7-5186471533 PUSKESMAS ELLY UYO JL. RAYA ENTROP, DISTRIK JAYAPURA SELATAN

99222 PUSKESMAS ELLY UYO PER/09/102016 RS.TRAUMA CENTRE

17/10/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


9 / 44607-11-201606:23:31



IKS


8 7-5186410453 PUSKESMAS ENTROP JL. TUANO ENTOP 99221 PUSKESMAS ENTROP PER/09/102016 RS.TRAUMA CENTRE 17/10/2016 31/12/2017

9 7-5186519706 PUSKESMAS HAMADI JL. PERIKANAN HAMADI DISTRIK JAYAPURA SELATAN 99221 PUSKESMAS HAMADI PER/09/102016 RS.TRAUMA

CENTRE 17/10/2016 31/12/2017

10 7-5186519917 PUSKESMAS IMBI KEL. IMBI DOK VIII, JAYAPURA UTARA 99117 PUSKESMAS IMBI PER/09/102016 RS.TRAUMA CENTRE

17/10/2016 31/12/2017

11 7-5186388411 PUSKESMAS JAYAPURA UTARA

JL. AHMAD YANI NO.70 A, JAYAPURA UTARA

99112 PUSKESMAS JAYAPURA UTARA


17/10/2016 31/12/2017

12 7-5186277418 PUSKESMAS KOTARAJA JL. RAYA ABEPURA KOTARAJA 99221 PUSKESMAS KOTARAJA PER/09/102016 RS.TRAUMA CENTRE 17/10/2016 31/12/2017

13 7-5186443782 PUSKESMAS KOYA BARAT JL. KOYA BARAT, DISTRIK MUARA TAMI 99351PUSKESMAS KOYA BARAT PER/09/102016

RS.TRAUMA CENTRE 17/10/2016 31/12/2017

14 7-5186387530 PUSKESMAS SKOUW KAMPUNG SKOUW MABO, DISTRIK MUARATAMI

00000 PUSKESMAS SKOUW PER/09/102016 RS.TRAUMA CENTRE

17/10/2016 31/12/2017

15 7-5186345069 PUSKESMAS TANJUNG RIA KEL. TANJUNG RIA, DISTRIK JAYAPURA UTARA

99112 PUSKESMAS TANJUNG RIA


17/10/2016 31/12/2017

16 7-5186519664 PUSKESMAS WAENAJL DOFONSORO PERUMNAS I WAENA, ABEPURA 99221 PUSKESMAS WAENA PER/09/102016

RS.TRAUMA CENTRE 17/10/2016 31/12/2017

17 7-5186179545 PUSKESMAS YOKA JL. YOKA 00000 PUSKESMAS YOKA PER/09/102016RS.TRAUMA CENTRE 17/10/2016 31/12/2017

18 1500000000455 RS BHAYANGKARA JL. JERUK NIPIS VURIA RS BHAYANGKARA PER/08/022015RS.TRAUMA CENTRE

26/02/2015 25/02/2017

19 1500000000524 RS BUNDA PENGHARAPAN MERAUKE

JL. ANGKASA I KELAPA LIMA MERAUKERS BUNDA PENGHARAPAN MERAUKE

PER/ 09/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016


Periode : 01/01/2015 s/d 31/10/2016


10 / 44607-11-201606:23:31



IKS


20 1500000000524 RS BUNDA PENGHARAPAN MERAUKE JL. ANGKASA I KELAPA LIMA MERAUKE

RS BUNDA PENGHARAPAN MERAUKE

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

21 1400000000375 RS DIAN HARAPAN TRAUMACENTER JL. TARUNA BHAKTI WAENA 572123 YAYASAN RS DIAN

HARAPAN PER/15/092015 RS.TRAUMA CENTRE 22/12/2015 31/12/2016

22 1500000000081 RS MARTHEN INDEY JL. DIPONEGORO NO. 27 GURABESI RSMI JAYAPURA PER/18/122015 RS.TRAUMA CENTRE

14/01/2016 31/12/2016

23 1400000000716 RSAL DR. SOEDIBJO SARDADI

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


14/01/2016 31/12/2016

24 1400000000514 RSAL MERAUKE TC JL. TRIKORA MERAUKE 321512 RSAL KAB. MERAUKE PER/16/112015 RS.TRAUMA CENTRE 22/12/2015 31/12/2016

25 1500000000525 RSUD ABEPURA JL. KESEHATAN NO. 1 ABEPURA RSUD ABEPURA PER/ 12/042015RS.TRAUMA CENTRE 01/04/2015 01/04/2016

26 1500000000525 RSUD ABEPURA JL. KESEHATAN NO. 1 ABEPURA RSUD ABEPURA PER/05/052016 RS.TRAUMA CENTRE

25/05/2016 31/12/2017

27 1500000000829 RSUD KABUPATEN SUPIORI JL. SORENDIWERI KORIDO SUPIORI 44976339 RSUD KABUPATEN SUPIORI


01/04/2015 30/04/2016

28 1500000000829 RSUD KABUPATEN SUPIORI JL. SORENDIWERI KORIDO SUPIORI 44976339RSUD KABUPATEN SUPIORI PER/07/052016

RS.TRAUMA CENTRE 25/05/2016 31/12/2017

29 1500000000454 RSUD KWAINGGA KEEROMJL. BHAYANGKARA KP ASYAMAN DISTRIK ARSO

0811488030

RSUD KWAINGGA KEEROM PER/01/032016

RS.TRAUMA CENTRE 20/06/2016 31/12/2017

30 1500000000454 RSUD KWAINGGA KEEROMJL. BHAYANGKARA KP ASYAMAN DISTRIK ARSO

0811488030

RSUD KWAINGGA KEEROM


25/02/2015 24/02/2016

31 1400000000515 RSUD MERAUKE TC JL. SUKARJO WIRYOPRANOTO NO. 1 085244682879

RSUD MERAUKE PER/16/112015 RS.TRAUMA CENTRE

22/12/2015 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


11 / 44607-11-201606:23:31



IKS


32 1500000000456 RSUD YOWARI JL RAYA SENTANI DEPAPRE DOYO BARU KABUPATEN JAYAPURA

085244906298 RSUD YOWARI PER/09/022015 RS.TRAUMA

CENTRE 25/02/2015 24/05/2016

33 1500000000456 RSUD YOWARI JL RAYA SENTANI DEPAPRE DOYO BARU KABUPATEN JAYAPURA

085244906298 RSUD YOWARI PER/08/052016 RS.TRAUMA

CENTRE 25/05/2016 31/12/2017

34 1500000000828 RUMKITAL DR. R GANDHI A.T BIAK

JL. JENDRAL SUDIRMAN BIAK 44265612 RUMKITAL DR. R GANDHI A.T BIAK


25/05/2016 31/12/2017

35 1500000000828 RUMKITAL DR. R GANDHI A.T BIAK

JL. JENDRAL SUDIRMAN BIAK 44265612 RUMKITAL DR. R GANDHI A.T BIAK


01/04/2015 29/04/2016

KANTOR CABANG : 102- KANTOR CABANG MIMIKA


IKS


1 1400000000460 KLINIK MAHAFIDIN MEDICAL CARE (MMC)

JLN BUDI UTOMO NO. 50 99910 082198760077

IWAN ANWAR SH PER/05/052016 RS.TRAUMA CENTRE

09/05/2016 31/12/2016

2 1400000000573 RSUD KABUPATEN ASMAT JLN AGATS KABUPATEN ASMAT PER/013/122014RS.TRAUMA CENTRE 01/01/2015 31/12/2015

3 1500000000258 RSUD KABUPATEN NABIRE LN. RE. MARTHADINATA NABIRE PAPUA 98811 RSUD NABIRE PER/07/072016RS.TRAUMA CENTRE 26/07/2016 31/12/2017

4 1500000000258 RSUD KABUPATEN NABIRE LN. RE. MARTHADINATA NABIRE PAPUA 98811 RSUD NABIRE PER/03/032015RS.TRAUMA CENTRE

01/03/2015 28/03/2016

5 1500000000174 RUMAH SAKIT MITRA MASYARAKAT

JLN. CHARITAS NO. 1 99910 0901324041

YAYASAN CARITAS PER/07/062016 RS.TRAUMA CENTRE

30/06/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


12 / 44607-11-201606:23:31



IKS


6 1500000000174 RUMAH SAKIT MITRA MASYARAKAT JLN. CHARITAS NO. 1 99910 090132404

1 YAYASAN CARITAS PER/02/022015 RS.TRAUMA CENTRE 01/02/2015 29/02/2016

7 1500000000345 RUMAH SAKIT UMUM DAERAH (RSUD) MIMIKA JLN YOS SUDARSO NAWARIPI 99910 0901-

3125200 RSUD MIMIKA PER/07/032015 RS.TRAUMA CENTRE 01/04/2015 30/04/2016

8 1500000000345 RUMAH SAKIT UMUM DAERAH (RSUD) MIMIKA

JLN YOS SUDARSO NAWARIPI 99910 0901-3125200

RSUD MIMIKA PER/04/042016 RS.TRAUMA CENTRE

01/05/2016 31/12/2016

KANTOR CABANG : A00- KANTOR CABANG LHOKSEUMAWE


IKS


1 1500000000446 KLINIK HUSADA LHOKSUKON

JL TGK CHIK DITUNONG GAMPONG KUTA LHOKSUKON KEC. LHOKSUKON KAB. ACEHUTARA

31120 JAMALUDDIN PER/10/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

2 1500000000446 KLINIK HUSADA LHOKSUKON

JL TGK CHIK DITUNONG GAMPONG KUTA LHOKSUKON KEC. LHOKSUKON KAB. ACEHUTARA

31120 JAMALUDDIN PER/08/052016 RS.TRAUMA CENTRE

15/06/2016 31/12/2016

3 1500000000228KLINIK LHOKSEUMAWE HUSADA

JLN. MERDEKA BARAT NO.12 F GAMPONG KUTA BLANG KEC. BANDA SAKTI

081396697999 DR. HJ. KIKIE INDRIATY PER/04/032016

RS.TRAUMA CENTRE 03/06/2016 31/12/2016


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

081396697999 DR. HJ. KIKIE INDRIATY PER/04/032016

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


JLN. MERDEKA BARAT NO.12 F GAMPONG KUTA BLANG KEC. BANDA SAKTI

081396697999

DR. HJ. KIKIE INDRIATY PER/04/022015RS.TRAUMA CENTRE

13/02/2015 12/02/2016

6 1500000000125 KLINIK MITA SEHAT JL. MEDAN-BANDA ACEH GAMPONG TAMBON BAROH KEC. DEWANTARA

085277907770

H. IRSYAD H. ABDULLAH PER/01/012015 RS.TRAUMA CENTRE

02/01/2015 01/01/2016


Periode : 01/01/2015 s/d 31/10/2016


13 / 44607-11-201606:23:31



IKS


7 1500000000229 KLINIK VINCA ROSEA LHOKSEUMAWE

JL. DARUSSALAM NO. 36 GAMPONG JAWA BARU AZHARI PER/19/122014 RS.TRAUMA

CENTRE 02/01/2015 01/01/2016

8 1500000000229 KLINIK VINCA ROSEA LHOKSEUMAWE

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

CENTRE 02/05/2016 31/12/2016

9 1500000000225 KLINIK VINCA ROSEA TAKENGON

JLN. ABDUL WAHAB KP. SIMPANG EMPAT KECAMATAN BEBESAN

AZHARI PER/07/052016 RS.TRAUMA CENTRE

02/05/2016 31/12/2016

10 1500000000225 KLINIK VINCA ROSEA TAKENGON

JLN. ABDUL WAHAB KP. SIMPANG EMPAT KECAMATAN BEBESAN

AZHARI PER/20/122014 RS.TRAUMA CENTRE

02/01/2015 01/01/2016

11 7-3779036883 OLASVI HEALTH AND CARE JL SAMUDERA BARU GAMPONG SIMPANG EMPAT KEC BANDA SAKTI 24352 CUT VIDYA HASSAN PER/10/062016 RS.TRAUMA

CENTRE 16/06/2016 31/12/2017

12 7-4350761123PRAKTEK UMUM DR. FERDIAN SUBHAN

JALAN MESJID NO 05 C DS UTEUNKOT KEC. MUARA DUA 24352 DR. FERDHIAN SUBHAN PER/13/082016

RS.TRAUMA CENTRE 12/08/2016 31/12/2017

13 7-4098235203 PRAKTEK UMUM DR. RIZA FAHMI

JL. MAYJEN T HAMZAH BENDAHARA NO 19-21 APOTIK KIMIA FARMA KABUPATEN BIREUEN

24251 DR. RIZA FAHMI PER/12/062016 RS.TRAUMA CENTRE

25/07/2016 31/12/2017

14 1500000000630 PUSKESMAS PAYA BAKONG JL TGK SYIK PAYA BAKONG CEUMPEUDAKKAB ACEH UTARA

DR. WELDI JUNAIDI 441/211/PKM/2015

RS.TRAUMA CENTRE

21/04/2015 20/04/2016

15 1500000000630 PUSKESMAS PAYA BAKONGJL TGK SYIK PAYA BAKONG CEUMPEUDAKKAB ACEH UTARA DR. WELDI JUNAIDI PER/10/052016

RS.TRAUMA CENTRE 10/05/2016 31/12/2016

16 7-1092257715RSUD DATU BERU KABUPATEN ACEH TENGAH

JL. RUMAH SAKIT UMUM NO. 153 TAKENGON 24511 064321396 DR. HARDI YANIS, SPPD PER/25/102015

RS.TRAUMA CENTRE 22/12/2015 31/12/2016

17 1500000000127RUMAH SAKIT AVICENNA BIREUEN

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

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

24/02/2016 31/12/2016

18 1500000000127 RUMAH SAKIT AVICENNA BIREUEN

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

22887 DR.FAISAL,SP.OG PER/02/012015 RS.TRAUMA CENTRE

01/02/2015 31/01/2016


Periode : 01/01/2015 s/d 31/10/2016


14 / 44607-11-201606:23:31



IKS


19 7-4091868453 RUMAH SAKIT BIREUEN MEDICAL CENTRE (BMC)

JALAN BIREUEN-TAKENGON KM 1,6 KECAMATAN JULI KABUPATEN BIREUEN 24251 064432305

5 DR LILI YULIANI PER/11/062016 RS.TRAUMA CENTRE 18/07/2016 31/12/2017

20 1500000000406 RUMAH SAKIT KASIH IBU JL MERDEKA NO 17 GP KUTA BLANG KEC BANDA SAKTI KOTA LHOKSEUMAWE 48713 HJ HERAWATI PER/05/022015 RS.TRAUMA

CENTRE 01/03/2015 29/02/2016

21 1500000000406 RUMAH SAKIT KASIH IBU JL MERDEKA NO 17 GP KUTA BLANG KEC BANDA SAKTI KOTA LHOKSEUMAWE

48713 HJ HERAWATI PER/09/062016 RS.TRAUMA CENTRE

29/06/2016 31/12/2016

22 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

23 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

24 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

25 1400000000691 RUMAH SAKIT UMUM BUNGA MELATI

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

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

26/02/2016 31/12/2016

KANTOR CABANG : A01- KANTOR CABANG BANDA ACEH


IKS


1 1500000000167BLUD RS IBU DAN ANAK ACEH

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

637433 PEMERINTAH ACEH PER/08/022015RS.TRAUMA CENTRE

04/02/2015 03/02/2016

2 1500000000167 BLUD RS IBU DAN ANAK ACEH

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

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

03/03/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


15 / 44607-11-201606:23:31



IKS


3 7-3959947033 BLUD RUMAH SAKIT JIWA ACEH

JL. DR. SYARIEF THAYEB NO. 25 GP. BANDAR BARU 23126 065132020 PEMERINTAH ACEH PER/28/062016 RS.TRAUMA

CENTRE 29/06/2016 31/12/2016

4 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

5 1500000000056 KLINIK AA MEDICAL JL SIGLI -KB. TANJONG NO.1 GP.PANTE KEC. SIMPANG TIGA KAB.PIDIE

HJ. AGUSMIATI, S.SI.T PER/03/012015 RS.TRAUMA CENTRE

07/01/2015 06/01/2016

6 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

7 1400000000566 KLINIK ATHARI JL. RUKOH UTAMA NO.21 GP. RUKOH KEC. SYIAH KUALA -KOTA BANDA ACEH

DR. TEUKU MUHAMMAD YUS PER/37/122015 RS.TRAUMA

CENTRE 12/01/2016 31/12/2016

8 1400000000670 KLINIK BUNDAJL.BANDA ACEH-MEDAN NO.1 GAMPONG BARO JAMAN KEC. MUTIARA ITA MUTIA PER/17/022016

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

9 1500000000122 KLINIK CAHAYA BUNDA JL. KEBUN RAJA GP. IE MASEN KEC. ULEE KARENG BATA KOTA BANDA ACEH

DR.BUDI PERMANA PER/06/012015 RS.TRAUMA CENTRE

28/01/2015 27/01/2016

10 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

11 1500000000055KLINIK KELUARGA ASMAULHUSNA GAMPONG ULEE GLE KEC BANDAR DUA SAIFUL BAHRI IDRIS PER/04/012016

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

12 1500000000153 KLINIK KIMIA FARMAJL. PERDAGANGAN NO. 1 KOTA SIGLI KEC. KOTA SIGLI KAB. PIDIE 21536

M. BAGUS ANDREAS TAUFANI, S.FARM, APT PER/11/022016

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

13 1500000000153 KLINIK KIMIA FARMAJL. PERDAGANGAN NO. 1 KOTA SIGLI KEC. KOTA SIGLI KAB. PIDIE

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


03/02/2015 02/02/2016

14 1500000000019 KLINIK LATIFAHJL. SOEKARNO -HATTA N0.04 DSN. MELATI GP. GAROT KEC. DARUL IMARAH KAB. ACEH BESAR

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

02/03/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


16 / 44607-11-201606:23:31



IKS


15 1500000000019 KLINIK LATIFAHJL. SOEKARNO -HATTA N0.04 DSN. MELATI GP. GAROT KEC. DARUL IMARAH KAB. ACEH BESAR

SISKA ARSYAD, S.KED PER/01/012015 RS.TRAUMA CENTRE 06/01/2015 05/01/2016

16 1500000001919 KLINIK MITRA MEDISTRA JL. RESIDEN DANUBROTO GP. LAMLAGANGKEC. BANDA RAYA 23111 AZIZURRAHMAN,

SKM,MM PER/24/072015 RS.TRAUMA CENTRE 01/08/2015 31/12/2015

17 1500000001919 KLINIK MITRA MEDISTRA JL. RESIDEN DANUBROTO GP. LAMLAGANGKEC. BANDA RAYA

23111 AZIZURRAHMAN, SKM,MM


10/02/2016 31/12/2016

18 1500000000105 KLINIK NABILA JL. STA. MAHMUDSYAH N0.9 GP.BARU KEC.BAITURRAHMAN

33555 DR. RACHMI KURNIAWATI


16/01/2015 15/01/2016

19 7-1676350253 KLINIK RANUP PEUNAWA MEDIKA

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

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

20 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

21 1400000000673 KLINIK SIWAH MEDIKA CENTER

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

LYDIA SEPTA DESIYANA,M.SI, APT


10/02/2016 31/12/2016

22 1500000000242 KLINIK UMMI AISYAH JL. PERDAGANGAN GAMPONG KUTA BARAT KOTA SABANG

MINALTIWATI, AMD.KEB PER/13/022105 RS.TRAUMA CENTRE

27/02/2015 26/02/2016

23 1500000000242 KLINIK UMMI AISYAHJL. PERDAGANGAN GAMPONG KUTA BARAT KOTA SABANG MINALTIWATI, AMD.KEB PER/18/022016

RS.TRAUMA CENTRE 27/02/2016 31/12/2016

24 1500000000569 PIUSKESMAS MONTASIKJLN. AYAHANDA TGK SYEKH IBRAHIM MONTASIK PASAR COT GOH, KEC MONTASIK

DINKES ACEH BESARPER / 19.16 / 042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

25 1500000000555 PUSKEMAS LHOKNGA DESA MONIKEN, PASAR LHOKNGADINAS KESEHATAN ACEH BESAR

PER / 19.02 / 042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

26 1500000000561 PUSKEMAS SEULIMUM JLN B.ACEH - MEDAN KM 42 DESA SEUNEBOK, SEULIMUM TLP. 93026

DINKES ACEH BESAR PER / 19.07 / 042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016


Periode : 01/01/2015 s/d 31/10/2016


17 / 44607-11-201606:23:31



IKS


27 1500000000567 PUSKESMAS BAITUSSALAM JL. LAKSAMANA MALAHAYATI KM. 10,5 KEC. BAITUSSALAM DINKES ACEH BESAR PER / 19.14 /

042015RS.TRAUMA CENTRE 01/04/2015 31/03/2016

28 1500000000581 PUSKESMAS BLANG BINTANG

DESA KAMPONG BLANG, KEC. BLANG BINTANG. JLN. SULTAN ISKANDAR MUDA DINKES ACEH BESAR PER / 19.28 /

042015RS.TRAUMA CENTRE 01/04/2015 31/03/2016

29 1500000000576 PUSKESMAS DARUL IMARAH

JLN. ELAK- BILUY (0651 ) 48375 48375 DINKES ACEH BESAR PER / 19.23 / 042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

30 1500000000577 PUSKESMAS DARUL KAMAL JLN. TGK FAKINAH KM.9 PEUKAN BILUY KODE POS 23352


RS.TRAUMA CENTRE

01/04/2015 31/03/2016

31 1500000000566 PUSKESMAS DARUSSALAM JL. LAMBARO ANGAN, KEC. DARUSSALAM, KODE POS 23373 DINKES ACEH BESAR PER / 19.13 /

042015RS.TRAUMA CENTRE 01/04/2015 31/03/2016

32 1500000000560 PUSKESMAS IE ALANG GAMPONG IE ALANG MESJID DINKES ACEH BESARPER / 19.07 / 042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

33 1500000000557 PUSKESMAS INDRAPURI JLN. B. ACEH - MEDAN KM 25 ( 0651 ) 24657 KODE POS 23363


RS.TRAUMA CENTRE

01/04/2015 31/03/2016

34 1500000000571 PUSKESMAS INGIN JAYA JLN. B.ACEH MEDAN KM 8,5 LAMBARO 2790 DINKES ACEH BESAR PER / 19.18 / 042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

35 1500000000563 PUSKESMAS KOTA JANTHOJLN. TEUREUBEH KOTA JANTHO TLP. (0651 )92601 KODE POS 23918 DINKES ACEH BESAR

PER / 19.10 / 042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

36 1500000000572PUSKESMAS KRUENG BARONA JAYA

JL. T. ISKANDAR, KM. 5 DESA COT IRIE, KEC. KRUENG BARONA JAYA DINKES ACEH BESAR

PER / 19.19 / 042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

37 1500000000568 PUSKESMAS KUTA BAROJL. BLANG BINTANG LAMA KM. 10,5 , PEUKAN ATEUK, KEC KUTA BARO KODE POS 23372 TLP. ( 0651 ) 581159


RS.TRAUMA CENTRE

01/04/2015 31/03/2016

38 1500000000559 PUSKESMAS KUTA COTGLIE JL. BANDA ACEH-MEDAN KM. 36, LAMPAKUK


RS.TRAUMA CENTRE

01/04/2015 31/03/2016


Periode : 01/01/2015 s/d 31/10/2016


18 / 44607-11-201606:23:31



IKS


39 1500000000574 PUSKESMAS KUTA MALAKA JL. BANDA ACEH-MEDAN KM. 19,5 SAMAHANI DINKES ACEH BESAR PER / 19.21 /

042015RS.TRAUMA CENTRE 01/04/2015 31/03/2016

40 1500000000579 PUSKESMAS LAMPISANG JL. B. ACEH-MEULABOH, DESA LAMPISANGKEC. PEUKAN BADA DINKES ACEH BESAR PER / 19.26 /

042015RS.TRAUMA CENTRE 01/04/2015 31/03/2016

41 1500000000558 PUSKESMAS LAMPUPOK JLN.BANDA ACEH MEDAN KM 23. LAMPUPOK RAYA, INDRAPURI


RS.TRAUMA CENTRE

01/04/2015 31/03/2016

42 1500000000562 PUSKESMAS LAMTEUBA DESA LAMTEUBA DROE, KEC. SEULIMUM. DINKES ACEH BESAR PER / 19.09 / 042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

43 1500000000564 PUSKESMAS LEMBAH SEULAWAH

GAMPONG ACEH SUKADAMAI, SAREE, KEC. LEMBAH SEULAWAH KODE POS 23952 DINKES ACEH BESAR PER / 19.11 /

042015RS.TRAUMA CENTRE 01/04/2015 31/03/2016

44 1500000000556 PUSKESMAS LEUPUNGJLN. B.ACEH - MEULABOH KM. 30 KEDE POS 23353 DINKES ACEH BESAR

PER / 19.03 / 042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

45 1500000000554 PUSKESMAS LHOONG JLN. B. ACEH - MEULABOH KM. 54 KODE POS 23354

DINAS KESEHATAN ACEH BESAR

PER / 19.01 / 042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

46 1500000000565 PUSKESMAS MESJID RAYA JL. LAKSAMANA MALAHAYATI DESA MEUNASAH KEUDE, KRUENG RAYA


RS.TRAUMA CENTRE

01/04/2015 31/03/2016

47 1500000000578 PUSKESMAS PEUKAN BADAJLN. MESJID TGK CHIK MAHARAJA GURAH NO. 03 KODE POS 23351 DINKES ACEH BESAR

PER / 19.25 / 042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

48 1500000000570 PUSKESMAS PIYEUNG JLN AYAHANDA DINKES ACEH BESARPER / 19.17 / 042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

49 1500000000580 PUSKESMAS PULO ACEHDESA LAMPUYANG, PULAU BREUH, KEC. PULO ACEH.


RS.TRAUMA CENTRE

01/04/2015 31/03/2016

50 1500000000575 PUSKESMAS SIMPANG TIGA JL. T. FAKINAH, DESA KRUENG MAK, SIMPANG TIGA


RS.TRAUMA CENTRE

01/04/2015 31/03/2016


Periode : 01/01/2015 s/d 31/10/2016


19 / 44607-11-201606:23:31



IKS


51 1500000000573 PUSKESMAS SUKAMAKMUR JLN. B. ACEH - MEDAN KM 16,5 SIBREH 7400250 DINKES ACEH BESAR PER / 19.20 / 042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

52 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

53 1400000000191 RS CITRA HUSADA SIGLI JL. PROF MAJID IBRAHIM LAMPEUDEU BAROH KOTA SIGLI KABUPATEN PIDIE

96707970 DR JULIANA SP AK PER/30/082016 RS.TRAUMA CENTRE

02/09/2016 31/12/2016

54 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

55 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

56 1500000001060 RSUD KAB. ACEH BESARJL. BANDA ACEH-MEDAN KM. 25 GP.SINYEU KEC. INDRAPURI, KABUPATEN ACEH BESAR

DINKES ACEH BESAR PER / 20/042015RS.TRAUMA CENTRE 01/04/2015 31/03/2016

57 1400000000692 RSUD KABUPATEN PIDIE JAYA

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


10/02/2016 31/12/2016

58 1500000001923 RSUD MEURAXA JL. SOEKARNO HATTA KM.2 MIBO KEC. BANDA RAYA

23111 43097 PEMERINTAH KOTA BANDA ACEH

PER/ 25/ 082015 RS.TRAUMA CENTRE

18/08/2015 17/08/2017

59 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

60 1500000000093 RUMAH SAKIT IBNU SINAJL 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

61 1500000000124RUMAH SAKIT MALAHAYATI

JL CUT NYAK DHIEN NO 498 LAMTEUMEN TIMUR

32874YAYASAN RS MALAHAYATI


16/01/2015 15/01/2016

62 1400000000194 RUMAH SAKIT TGK FAKINAH

JL. JEND SUDIRMAN NO. 17, KOTA BANDA ACEH

44114 YAYASAN TGK FAKINAH PER/23/072015 RS.TRAUMA CENTRE

01/07/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


20 / 44607-11-201606:23:31



IKS


63 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

64 1400000000570 RUMAH SAKIT U'BUDIYAH 7555750 PT. CAISARIO ROYAL PRATAMA PER/35/122015 RS.TRAUMA

CENTRE 12/01/2016 31/12/2016

65 1500000000302 RUMAH SAKIT UMUM BULAN SABIT MERAH

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

HERI RISWANDI PER/21/032016 RS.TRAUMA CENTRE

03/03/2016 31/12/2016

66 1500000000302 RUMAH SAKIT UMUM BULAN SABIT MERAH

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

HERI RISWANDI PER/16/ 032015 RS.TRAUMA CENTRE

02/03/2015 01/03/2016

67 1500000000166 RUMKIIT BHAYANGKARA JL. CUT NYAK DHIEN NO. 1 KEL. LAMTEUMEN 41470 KEPOLISIAN REPUBLIK

INDONESIA PER/09/022015 RS.TRAUMA CENTRE 05/02/2015 04/02/2016

68 1500000000166 RUMKIIT BHAYANGKARAJL. CUT NYAK DHIEN NO. 1 KEL. LAMTEUMEN 41470

KEPOLISIAN REPUBLIK INDONESIA PER/22/032016

RS.TRAUMA CENTRE 07/04/2016 31/12/2016

69 7-2832361743 RUMKIT TK II ISKANDAR MUDA BANDA ACEH

JL T. HAMZAH BENDAHARA NO 1 KOTA BANDA ACEH

23121 KEENTRIAN PERTAHANAN RI


07/04/2016 31/12/2016

KANTOR CABANG : A02- KANTOR CABANG LANGSA


IKS


1 1400000000546DR. SYARIFAH RINA MARLINA

JL. H AGUSSALIM NO. 20 KAMPUNG BLANG LANGSA KOTA

20354DR. SYARIFAH RINA MARLINA


21/01/2016 31/12/2016

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

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

15/03/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


21 / 44607-11-201606:23:31



IKS


3 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

4 7-4892831346 KLINIK HABIBJLN BANDA ACEH-MEDAN SP. KAPAL DESAIE BINTAH KEC MANYAK PAYED KABUPATEN ACEH TAMIANG

24474 SAID HANAFIAH SKM M.KES 7-4892831346 RS.TRAUMA

CENTRE 22/09/2016 31/12/2016

5 7-4900077535 KLINIK K.S.U WASSALAM JLN PONDOK PUTIH KP SELAMAT KEC TENGGULUN KAB ACEH TAMIANG

24477 SAIFUL ZUHRI S.E 7-4900077535 RS.TRAUMA CENTRE

22/09/2016 31/12/2016

6 1500000000039 PUSKESMAS BANDA MULIA KECAMATAN BANDA MULIA 085275453457

COCO ARMANSYAH, SKM


01/01/2015 31/12/2015

7 1500000000037 PUSKESMAS BANDAR PUSAKA KECAMATAN BANDAR PUSAKA 085363910

858 SYAMSUDDIN, SKM PER/14/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

8 1500000000037PUSKESMAS BANDAR PUSAKA KECAMATAN BANDAR PUSAKA

085363910858 SYAMSUDDIN, SKM PER/04/012016

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

9 1500000000023 PUSKESMAS BENDAHARA KECAMATAN BENDAHARA 085277213585

RADHIYAH, SKM PER/02/012015 RS.TRAUMA CENTRE

02/01/2015 31/12/2015

10 1500000000024 PUSKESMAS KARANG BARU KECAMATAN KARANG BARU 085276981936

SARI INDAH FITHRIANY, SA.SKM


02/01/2015 31/12/2015

11 1500000000042PUSKESMAS KEJURUAN MUDA KECAMATAN KEJURUAN MUDA

085275231971 HJ. MULYANI, S.KEP PER/09/012015

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

12 1500000000043PUSKESMAS KOTA KUALA SIMPANG KECAMATAN KUALA SIMPANG

085272110394 IDA IRAWATI PER/08/012015

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

13 1500000000398PUSKESMAS LANGSA BARAT

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

23093AYU ARTLINTA, SKM, M.KES


10/03/2016 31/12/2016

14 1500000000398 PUSKESMAS LANGSA BARAT

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

23093 AYU ARTLINTA, SKM, M.KES


02/02/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


22 / 44607-11-201606:23:31



IKS


15 1500000000396 PUSKESMAS LANGSA BARO JL. LILAWANGSA NO. 01 PAYA BUJOK TUNONG KEC LANGSA BARO SAFRITA, SKM PER/22/012016 RS.TRAUMA

CENTRE 10/03/2016 31/12/2016

16 1500000000396 PUSKESMAS LANGSA BARO JL. LILAWANGSA NO. 01 PAYA BUJOK TUNONG KEC LANGSA BARO SAFRITA, SKM PER/17/022015 RS.TRAUMA

CENTRE 02/02/2015 31/12/2015

17 1500000000522 PUSKESMAS LANGSA KOTA JLN H. AGUS SALIM NO. 10 SUNGAI PAUH KEC LANGSA BARAT KOTA LANGSA

69222267 DR. T CHIK M. IQBAL F PER/15/022015 RS.TRAUMA CENTRE

01/02/2015 31/12/2015

18 1500000000522 PUSKESMAS LANGSA KOTA JLN H. AGUS SALIM NO. 10 SUNGAI PAUH KEC LANGSA BARAT KOTA LANGSA

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

10/03/2016 31/12/2016

19 1500000000395 PUSKESMAS LANGSA LAMA JL PENDIDIKAN DS MEURANDEH DAYA KEC LANGSA LAMA

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

CENTRE 10/03/2016 31/12/2016

20 1500000000395 PUSKESMAS LANGSA LAMAJL PENDIDIKAN DS MEURANDEH DAYA KEC LANGSA LAMA

NS. EDI SYAHPUTRA, S.KEP PER/19/022015

RS.TRAUMA CENTRE 02/02/2015 31/12/2015

21 1500000000397 PUSKESMAS LANGSA TIMUR JL. MEDAN-BANDA ACEH KM. 7 GP ALUE PINEUNG KEC LANGSA TIMUR

DR. MAHLIDAYANTI PER/18/022015 RS.TRAUMA CENTRE

02/02/2015 31/12/2015

22 1500000000397 PUSKESMAS LANGSA TIMUR JL. MEDAN-BANDA ACEH KM. 7 GP ALUE PINEUNG KEC LANGSA TIMUR

DR. MAHLIDAYANTI PER/25/012016 RS.TRAUMA CENTRE

07/03/2016 31/12/2016

23 1500000000022PUSKESMAS MANYAK PAYED KECAMATAN MANYAK PAYED

085358091334 DR. FITRIYANTI PER/01/012015

RS.TRAUMA CENTRE 02/01/2015 31/12/2015

24 1500000000045 PUSKESMAS RANTAU KECAMATAN RANTAU081260441263

DR TSUAIBAHTUL ASLAMIYAH NASUTION PER/06/012015

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

25 1500000000044 PUSKESMAS SAPTA JAYA KECAMATAN SAPTA JAYA085260746332

DR. DANANG ARMAN MUNANTO


01/01/2015 31/12/2015

26 1500000000040 PUSKESMAS SEKERAK KECAMATAN SEKERAK 082168103036

DR. ABDUL GAFUR PER/11/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


23 / 44607-11-201606:23:31



IKS


27 1500000000026 PUSKESMAS SERUWAY KECAMATAN SERUWAY 085270118101 JAMILAH, SKM PER/04/012015 RS.TRAUMA

CENTRE 02/01/2015 31/12/2015

28 1500000000038 PUSKESMAS SIMPANG KIRI KECAMATAN SIMPANG KIRI 081265193134

DR. SANDY PRAMAYUDHA PER/13/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

29 1500000000025 PUSKESMAS SUNGAI IYU DS SUNGAI IYU KECAMATAN BENDAHARA 08126317369

IRWANUDDIN, SKM PER/03/012015 RS.TRAUMA CENTRE

02/01/2015 31/12/2015

30 1500000000041 PUSKESMAS TAMIANG HULU

KECAMATAN TAMIANG HULU 08116133319

DRG. MIKYAL AYYA RIEFKA


01/01/2015 31/12/2015

31 1400000000340 RSU CUT MEUTIA JL GARUDA NOMOR 1 KEBUN BARU KECAMATAN LANGSA BARO 23071 IR EDDY PURNOMO PER/06/122014 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

32 1400000000340 RSU CUT MEUTIAJL GARUDA NOMOR 1 KEBUN BARU KECAMATAN LANGSA BARO 23071 IR EDDY PURNOMO PER/25/122015

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

33 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

34 1400000000675 RSU CUT NYAK DHIEN JL. T.M. BACHRUM NO 1 KOTA LANGSA 22228 DR YUSUF, MM PER/10/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

35 7-2502904553 RSUD ACEH TAMIANG JL KESEHATAN KEC KARANG BARU 24476PEMERINTAH KABUPATEN ACEH TAMIANG

PER/20/01/012016

RS.TRAUMA CENTRE 14/03/2016 31/12/2016

36 1500000000034 RSUD KOTA LANGSAJALAN JEND. AHMAD YANI NO 1 KOTA LANGSA 22051 DR. HERMAN I PER/11/122014

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

37 1500000000034 RSUD KOTA LANGSAJALAN JEND. AHMAD YANI NO 1 KOTA LANGSA

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

27/01/2016 31/12/2016

38 1400000000674 RUMAH SAKIT UMUM UMMIJL PROF A.MAJID IBRAHIM DUSUN SATRIA RT 02 SUNGAI PAUH KECAMATAN LANGSA BARAT

22886 DR. SAID MUHAMMAD FACHRIANSYAH


16/02/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


24 / 44607-11-201606:23:31


KANTOR CABANG : A03- KANTOR CABANG MEULABOH


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 RAMBOT DESA 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/10/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

8 1500000000004PUSKESMAS BEUTONG ATEUH

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

08/01/2016 31/12/2016

9 1500000000010 PUSKESMAS COT KUTA JL. NASIONAL MBO-JEURAM, KEC. SEUNAGAN

23671 NEVI HASNITA, SKM PER/09/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

10 1400000000631 PUSKESMAS 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/31/122015

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

12 1500000000008 PUSKESMAS JEURAM JL. KESEHATAN NO.2, KEC. SEUNAGAN 23671 NURZAINI PER/33/122015RS.TRAUMA CENTRE 08/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


25 / 44607-11-201606:23:31



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 : 01/01/2015 s/d 31/10/2016


26 / 44607-11-201606:23:31



IKS


25 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

26 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

27 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

28 1500000000016 PUSKESMAS TANGKEH DS. TANGKEH, KEC. WOYLA TIMUR 23682 ADNEN AR, AMK PER/35/122015 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

29 1500000000009 PUSKESMAS UJONG FATIHAH DS. BLANG MUKO, KEC. KUALA 23661 CUT NIH PER/38/122015 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

30 1500000000014 PUSKESMAS UTEUN PULODS. BLANG PANYANG, KEC. SEUNANGAN TIMUR 23671 HJ. YUSNIDAR PER/36/122015

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

31 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

32 1500000000246 RSU SWASTA HARAPAN SEHAT MEULABOH

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

23615 DR. MURDIATI M. KES PER/40/022016 RS.TRAUMA CENTRE

03/03/2016 31/12/2016

33 1500000000246RSU SWASTA HARAPAN SEHAT MEULABOH

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

23615 DR. MURDIATI M. KES PER/06/022015RS.TRAUMA CENTRE 01/02/2015 31/01/2016

34 1400000000379RSU SWASTA MONTELLA MEULABOH

JL. BERINGIN JATA DUSUN COT GAMPONG SEUNEUBOK KEC. JOHAN PAHLAWAN

SYARIFAH MERI MERDIANA, S.SI.,APT PER/02/092015

RS.TRAUMA CENTRE 31/12/2015 31/08/2016

35 1400000000379RSU SWASTA MONTELLA MEULABOH

JL. BERINGIN JATA DUSUN COT GAMPONG SEUNEUBOK KEC. JOHAN PAHLAWAN

SYARIFAH MERI MERDIANA, S.SI.,APT


01/09/2016 31/08/2017

36 1500000000245 RSUD ACEH SINGKIL JL. RIMO-SINGKIL KM.8 ACEH SINGKIL PEMDA ACEH SINGKIL PER/04/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


27 / 44607-11-201606:23:31



IKS


37 1500000000245 RSUD ACEH SINGKIL JL. RIMO-SINGKIL KM.8 ACEH SINGKIL PEMDA ACEH SINGKIL PER/17/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

38 1400000000273 RSUD CUT NYAK DHIEN MEULABOH JL. GAJAH MADA MEULABOH 23616 21137 PEMKAB ACEH BARAT PER/01/062015 RS.TRAUMA

CENTRE 29/12/2015 30/06/2016

39 1400000000273 RSUD CUT NYAK DHIEN MEULABOH

JL. GAJAH MADA MEULABOH 23616 21137 PEMKAB ACEH BARAT PER/01/062016 RS.TRAUMA CENTRE

14/07/2016 30/06/2017

40 1500000000136 RSUD DR H YULIDDIN AWAY

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

323615 PEMKAB ACEH SELATAN PER/43/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

41 1500000000136 RSUD 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

42 1500000000123RSUD KOTA SUBULUSSALAM

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

62731700PEMKOT SUBULUSSALAM PER/15/122015

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

43 1500000000123 RSUD KOTA SUBULUSSALAM

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

62731700 PEMKOT SUBULUSSALAM


01/01/2015 31/12/2015

44 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

45 1500000000015 RSUD TEUNGKU PEUKAN BLANG PIDIE,ACEH BARAT DAYA 92522DARUSMAN, M.KES (MMR) PER/11/122015

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

46 1400000000614RUMAH 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


Periode : 01/01/2015 s/d 31/10/2016


28 / 44607-11-201606:23:31



IKS


1 1400000000127 BP HARAPAN BUNDA JL. BRIGJEND ZEIN HAMID NO 39 TITI KUNING 7852636 NETTY BARITA, SE PER/21/122014 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

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 1500000000065 BP HARAPAN BUNDA 1 JL BALAI DESA NO 7 MEDAN POLONIA 6504129 NETTY BARITA,SE PER/22/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

5 1500000000066 BP HARAPAN BUNDA 3 JL BRIGJEN KATAMSO NO 440 B NETTY BARITA SE PER/23/122014 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

6 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

7 1500000000201 BP KURNIA JL BINJAI KM 8.8 NO 11 KP LALANG MEDAN 850915 TAN ERFI PER/21/022015 RS.TRAUMA CENTRE

18/02/2015 17/02/2016

8 1500000000201 BP KURNIA JL BINJAI KM 8.8 NO 11 KP LALANG MEDAN 850915 TAN ERFI PER/20/022016 RS.TRAUMA CENTRE

22/02/2016 31/12/2016

9 1500000000199KLINIK ADISMA HUSADA DARUSSALAM JL DARUSSALAM NO 5A 4153169 DR H SAYID BUDHI PER/16/022016

RS.TRAUMA CENTRE 17/02/2016 31/01/2017

10 1500000000199KLINIK ADISMA HUSADA DARUSSALAM JL DARUSSALAM NO 5A 4153169 DR H SAYID BUDHI PER/13/012015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

11 1500000000198KLINIK ADISMA HUSADA TEMBUNG

JL BESAR MEDAN BATANG KUIS DSN XI TEMBUNG

7383103 DR SAYID BUDHI PER/17/022016RS.TRAUMA CENTRE

17/02/2016 31/01/2017

12 1500000000198 KLINIK ADISMA HUSADA TEMBUNG

JL BESAR MEDAN BATANG KUIS DSN XI TEMBUNG

7383103 DR SAYID BUDHI PER/14/012015 RS.TRAUMA CENTRE

01/02/2015 31/01/2016


Periode : 01/01/2015 s/d 31/10/2016


29 / 44607-11-201606:23:31



IKS


13 1500000000196 KLINIK AKSARA JL AKSARA NO 120 MEDAN 97374384 TEGUH SUHARTO, SE PER/16/012015 RS.TRAUMA CENTRE 01/02/2015 31/01/2016

14 1500000000196 KLINIK AKSARA JL AKSARA NO 120 MEDAN 97374384 TEGUH SUHARTO, SE PER/23/022016 RS.TRAUMA CENTRE 24/02/2016 31/12/2016

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

6103683 DRG AMETA PRIMASARI TARIGAN


18/02/2016 31/01/2017

16 1500000000206 KLINIK AVIATI 1 JL JAMIN GINTING NO 15 P BULAN MEDAN BARU

6103683 DRG AMETA PRIMASARI TARIGAN


01/02/2015 31/01/2016

17 1500000000207 KLINIK AVIATI 3 JL JAMIN GINTING KM 8.5 KOMP DELTA NO 5 MEDAN TUNTUNGAN 3436450 DRG AMETA PRIMASARI

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

18 1500000000207 KLINIK AVIATI 3JL JAMIN GINTING KM 8.5 KOMP DELTA NO 5 MEDAN TUNTUNGAN 3436450

DRG AMETA PRIMASARI TARIGAN PER/10/012015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

19 1500000000203 KLINIK AZIZZI GATOT SUBROTO

JL JEND GATOT SUBROTO NO 333 MEDAN 4155528 DRS H RAZALI ROHIMUN PER/11/012015 RS.TRAUMA CENTRE

01/02/2015 31/01/2016

20 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

21 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

22 1500000000202 KLINIK AZIZZI SUMARSONO JL KAPT SUMARSONO NO 74 MEDAN 80030330 DR RIYADH IKHSAN PER/12/012015RS.TRAUMA CENTRE 01/02/2015 31/01/2016

23 1500000000194 KLINIK BERSAMA JL JAMIN GINTING NO 502 P BULAN MEDAN 68272131 SAMPE REZEKI, SE PER/24/022016RS.TRAUMA CENTRE

24/02/2016 31/12/2016

24 1500000000194 KLINIK BERSAMA JL JAMIN GINTING NO 502 P BULAN MEDAN 68272131 SAMPE REZEKI, SE PER/15/012015 RS.TRAUMA CENTRE

01/02/2015 31/01/2016


Periode : 01/01/2015 s/d 31/10/2016


30 / 44607-11-201606:23:31



IKS


25 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

26 1400000000126 KLINIK CITRA MEDIKA JALAN SISINGAMANGARAJA NO 7 KM 4,5 7863134 DR YUDHA PRAYOGI PER/20/122014 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

27 1500000000195 KLINIK GRIYA MEDICAL CENTER

JL KAPTEN MUSLIM NO 43B 97374384 TEGUH SUHARTO,SE PER/22/022016 RS.TRAUMA CENTRE

22/02/2016 31/12/2016

28 1500000000195 KLINIK GRIYA MEDICAL CENTER

JL KAPTEN MUSLIM NO 43B 97374384 TEGUH SUHARTO,SE PER/17/012015 RS.TRAUMA CENTRE

01/02/2015 31/01/2016

29 1500000000189 KLINIK MADANI JL. BESAR NAMORAMBE TITI KUNING 7032626 DR. H DEPI MASRI PER/12/122015 RS.TRAUMA CENTRE 07/01/2016 31/12/2016

30 1500000000189 KLINIK MADANI JL. BESAR NAMORAMBE TITI KUNING 7032626 DR. H DEPI MASRI PER/08/012015RS.TRAUMA CENTRE 01/02/2015 31/12/2015

31 1500000001611 KLINIK MILLENIUM JL KAPTEN MUSLIM NO 58C 63792195 SRI REZEKI SE PER/27/022016 RS.TRAUMA CENTRE

01/03/2016 31/12/2016

32 1500000001611 KLINIK MILLENIUM JL KAPTEN MUSLIM NO 58C 63792195 SRI REZEKI SE PER/27/022015 RS.TRAUMA CENTRE

01/03/2015 29/02/2016

33 1500000000197KLINIK SENYUM JAYA ABADI JL SETIABUDI NO 117 LINK V TG SARI 8219006

DRG ERITA FLORA MANURUNG PER/23/022015

RS.TRAUMA CENTRE 18/02/2015 17/02/2016

34 1500000000197KLINIK SENYUM JAYA ABADI JL SETIABUDI NO 117 LINK V TG SARI 8219006

DRG ERITA FLORA MANURUNG PER/28/022016

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

35 7-2460143493MURNI TEGUH MEMORIAL HOSPITAL

JL JAWA NO 2 MEDAN 20231 80501888 PT MURNI SADAR PER/33/022016RS.TRAUMA CENTRE

08/03/2016 31/12/2016

36 1500000000270 PUSKESMAS AMPLAS JL SM RAJA 7862798 PER/25/022015.01

RS.TRAUMA CENTRE

24/02/2015 23/02/2020


Periode : 01/01/2015 s/d 31/10/2016


31 / 44607-11-201606:23:31



IKS


37 1500000000271 PUSKESMAS BESTARI JL ROTAN KOMP PETISAH 4150066 PER/25/022015.02

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

38 1500000000280 PUSKESMAS DARUSSALAM JL DARUSSALAM PER/25/022015.03

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

39 1500000000279 PUSKESMAS DESA LALANG JL BINJAI KM 7.5 5237868 PER/02/2015.04 RS.TRAUMA CENTRE

24/02/2015 23/02/2020

40 1500000000278 PUSKESMAS HELVETIA JL CEMPAKA PERUMNAS HELVETIA 8451226 PER/25/022015.05

RS.TRAUMA CENTRE

24/02/2015 23/02/2020

41 1500000000275 PUSKESMAS KAMPUNG BARU JL BRIG KATAMSO/PS SENIN PER/25/022015.0

8RS.TRAUMA CENTRE 24/02/2015 23/02/2020

42 1500000000277 PUSKESMAS KEDAI DURIAN KEDAI DURIAN 7032005PER/25/022015.06

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

43 1500000000276 PUSKESMAS KOTA MATSUM JL AMALIUN PER/25/022015 RS.TRAUMA CENTRE

24/02/2015 23/02/2020

44 1500000000274 PUSKESMAS MEDAN JOHOR JL KARYA DHARMA PER/25/022015.09

RS.TRAUMA CENTRE

24/02/2015 23/02/2020

45 1500000000273PUSKESMAS MEDAN POLONIA JL POLONIA

PER/25/022015.10

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

46 1500000000272PUSKESMAS MEDAN SUNGGAL SUNGGAL

PER/25/022015.11

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

47 1500000000269PUSKESMAS PADANG BULAN

JL JAMIN GINTINGPER/25/022015.12

RS.TRAUMA CENTRE

24/02/2015 23/02/2020

48 1500000000268 PUSKESMAS PASAR MERAH HM JONI PER/25/022015.13

RS.TRAUMA CENTRE

24/02/2015 23/02/2020


Periode : 01/01/2015 s/d 31/10/2016


32 / 44607-11-201606:23:31



IKS


49 1500000000267 PUSKESMAS PB SELAYANG II BUNGA WIJAYA KUSUMA PER/25/022015.1

4RS.TRAUMA CENTRE 24/02/2015 23/02/2020

50 1500000000266 PUSKESMAS RANTANG RANTANG PER/25/022015.15

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

51 1500000000265 PUSKESMAS SIMALINGKAR JL BAWANG RAYA PER/25/022015.16

RS.TRAUMA CENTRE

24/02/2015 23/02/2020

52 1500000000264 PUSKESMAS SIMPANG LIMUN

JL KEMIRI PER/25/022015.17

RS.TRAUMA CENTRE

24/02/2015 23/02/2020

53 1500000000263 PUSKESMAS SUKARAMAI JL DENAI PER/25/022015.18

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

54 1500000000262 PUSKESMAS TELADAN JL SM RAJAPER/25/022015.19

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

55 1500000000261 PUSKESMAS TUNTUNGAN JL BUNGA MELATI PER/25/022015.20

RS.TRAUMA CENTRE

24/02/2015 23/02/2020

56 1500000000191 RS ADVENT MEDAN JL GATOT SUBROTO KM 4 MEDAN 4524875 YAYASAN RS ADVENT MEDAN


26/02/2016 31/12/2016

57 1500000000191 RS ADVENT MEDAN JL GATOT SUBROTO KM 4 MEDAN 4524875YAYASAN RS ADVENT MEDAN PER/19/022015

RS.TRAUMA CENTRE 16/02/2015 15/02/2016

58 1500000000190 RS BHAYANGKARA MEDAN JL.KH WAHID HASYIM NO 1 MEDAN 8215990 POLDA SUMUT PER/18/022015RS.TRAUMA CENTRE 01/03/2016 31/12/2016

59 1500000000190 RS BHAYANGKARA MEDAN JL.KH WAHID HASYIM NO 1 MEDAN 8215990 POLDA SUMUT PER/18/022015RS.TRAUMA CENTRE

12/02/2015 11/02/2016

60 7-4529675533 RS COLUMBIA ASIA MEDAN JL LISTRIK NO 2A MEDAN 20112 PT NUSAUTAMA MEDICALINDO


01/09/2016 31/08/2017


Periode : 01/01/2015 s/d 31/10/2016


33 / 44607-11-201606:23:31



IKS


61 1500000000077 RS ESTOMIHI JL SISINGAMANGARAJA NO 235 7861771 DR. M SAMOSIR, SP.PD PER/17/122014 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

62 1400000000125 RS ESTOMIHI JL. SISINGAMANGARAJA NO 235 7861771 DR. M. SAMOSIR,SP.PD PER/17/122014 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

63 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

64 1400000000129 RS ISLAM MALAHAYATI JL. PANGERAN DIPONEGORO NO 2-4 4518766 YAY RS MALAHAYATI PER/16/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

65 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

66 1500000000208RS 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

67 1500000000208 RS MARTHA FRISKA MULTATULI

JL MULTATULI KOMP MULTATULI INDAH NO 1

4149666 PT KARYA UTAMA SEHAT SEJAHTERA


16/02/2015 15/02/2016

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


13/04/2016 31/12/2016

69 1500000000537 RS ROYAL PRIMA JL AYAHANDA NO 68 A 88813182YAYASAN PERG TINGGI PRIMA INDONESIA PER/56/042015

RS.TRAUMA CENTRE 13/04/2015 12/04/2016

70 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

71 1500000000089 RSU BINA KASIH JL JEND TB SIMATUPANG NO 148 SUNGGAL 8475111YAYASAN BINA KASIH ABADI


19/01/2015 31/12/2015

72 1500000000089 RSU BINA KASIH JL JEND TB SIMATUPANG NO 148 SUNGGAL 8475111 YAYASAN BINA KASIH ABADI


07/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


34 / 44607-11-201606:23:31



IKS


73 1500000000091 RSU HERNA MEDAN JL MOJOPAHIT NO 118A MEDAN 4510766 YAY TD PARDEDE FOUNDATION PER/04/012015 RS.TRAUMA

CENTRE 15/01/2015 31/12/2015

74 1500000000091 RSU HERNA MEDAN JL MOJOPAHIT NO 118A MEDAN 4510766 YAY TD PARDEDE FOUNDATION PER/05/122015 RS.TRAUMA

CENTRE 07/01/2016 31/12/2016

75 1500000000624 RSU MATERNA JL TEUKU UMAR NO 11 MEDAN 4514222 PT RUMAH SAKIT MATERNA


25/04/2016 31/12/2016

76 1500000000624 RSU MATERNA JL TEUKU UMAR NO 11 MEDAN 4514222 PT RUMAH SAKIT MATERNA


23/04/2015 22/04/2016

77 1400000000124 RSU MITRA SEJATI JL. AH NASUTION NO. 7 P. MASYHUR MEDAN 7875967 YAY. MITRA SEJATI PER/18/122014 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

78 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

79 1500000000090 RSU PROF DR BOLONI JL MONGONSIDI NO 11 MEDAN 4512687 YAY PROF DR BOLONI MARPAUNG


07/01/2016 31/12/2016

80 1500000000090 RSU PROF DR BOLONI JL MONGONSIDI NO 11 MEDAN 4512687 YAY PROF DR BOLONI MARPAUNG


19/01/2015 31/12/2015

81 1500000000092 RSU SARI MUTIARA JL KAPTEN MUSLIM NO 79 MEDAN 8451812YAY SARI MUTIARA MEDAN PER/08/122015

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

82 1400000000123 RSU SARI MUTIARA JL. KAPTEN MUSLIM NO 79 MEDAN 8451812YAY SARI MUTIARA MEDAN PER/19/122014

RS.TRAUMA CENTRE 01/02/2015

83 1500000000092 RSU SARI MUTIARA JL KAPTEN MUSLIM NO 79 MEDAN 8451812YAY SARI MUTIARA MEDAN


01/01/2015 31/12/2015

84 1500000000200 RSU VINA ESTETICA JL SULTAN ISKANDAR MUDA NO 119 4147646 YAYASAN VINA ESTETICA


18/02/2015 17/02/2016


Periode : 01/01/2015 s/d 31/10/2016


35 / 44607-11-201606:23:31



IKS


85 1500000000200 RSU VINA ESTETICA JL SULTAN ISKANDAR MUDA NO 119 4147646 YAYASAN VINA ESTETICA PER/30/022016 RS.TRAUMA

CENTRE 01/03/2016 31/12/2016

86 1500000001551 RSUP HAJI ADAM MALIK JL BUNGA LAU NO 17 MEDAN 8364581 KEMENTERIAN KESEHATAN RI PER/57/042015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2017

87 7-1375319217 RUMAH SAKIT SETIABUDI JL MESJID NO 3 TANJUNG REJO MEDAN 20122 DR OTMAN SIREGAR SPOT


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 1400000000051 BPS SERASI JL. JEND. A. YANI NO. 179K 28756 TAN ERFI PER/01/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

3 1500000000249 KLINIK AINON JL.MEDAN KM 4.5 NO.44 6205667 PAUL PARULIAN PURBA PER/40/012016RS.TRAUMA CENTRE 15/04/2016 28/02/2017

4 1500000000249 KLINIK AINON JL.MEDAN KM 4.5 NO.44 6205667 PAUL PARULIAN PURBA PER/20/032015RS.TRAUMA CENTRE 01/03/2015 28/02/2016

5 1500000001829 KLINIK BERSAMA JL MERDEKA NO.47/67 21111 70532010DR.TIORI RORIA MAGDALENA


01/07/2015 30/06/2016

6 1500000000291 KLINIK KASIHHUTA II BENDO NAGORI DUSUN ULU KEC. UJUNG PADANG KABUPAETN SIMALUNGUN

72908220 DR. SEVEN APRI H SAMOSIR


11/05/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


36 / 44607-11-201606:23:31



IKS


7 1500000000291 KLINIK KASIHHUTA II BENDO NAGORI DUSUN ULU KEC. UJUNG PADANG KABUPAETN SIMALUNGUN

72908220 DR. SEVEN APRI H SAMOSIR PER/21/032015 RS.TRAUMA

CENTRE 01/03/2015 28/02/2016

8 1500000000148 KLINIK KELUARGA JL MEDAN NO.18 KM 4 28951 IR.AGUSTINUS SIANIPAR PER/16/022015 RS.TRAUMA CENTRE 01/02/2015 31/01/2016

9 1500000000148 KLINIK KELUARGA JL MEDAN NO.18 KM 4 28951 IR.AGUSTINUS SIANIPAR PER/43/052016 RS.TRAUMA CENTRE

10/05/2016 31/12/2016

10 1400000000553 KLINIK MURNI JL MELANTHON SIREGAR NO.206 6204978 APRIMO MP SIBARANI PER/35/TC/012016

RS.TRAUMA CENTRE

13/01/2016 31/12/2016

11 1400000000527 KLINIK PANDU JL. SM. RAJA NO. 627 PERDAGANGAN ANTONIUS PER/36/TC/012016

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

12 1500000000237 KLINIK PUTERI KEMBAR DALIL TANI NO.40 62164746 HERDIANA GULTOM PER/19/032015RS.TRAUMA CENTRE 01/03/2015 28/02/2016

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

10/05/2016 31/12/2016

14 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

15 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

16 1500000000236 KLINIK RIDHOJALAN SISINGAMANGARAJA NAGORI BALIMBINGAN KECAMATAN TANAH 64530224 DR. MENTI SIBURIAN PER/18/032015

RS.TRAUMA CENTRE 01/03/2015 28/02/2016

17 1500000000236 KLINIK RIDHOJALAN SISINGAMANGARAJA NAGORI BALIMBINGAN KECAMATAN TANAH

64530224 DR. MENTI SIBURIAN PER/45/052016RS.TRAUMA CENTRE

10/05/2016 31/12/2016

18 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


Periode : 01/01/2015 s/d 31/10/2016


37 / 44607-11-201606:23:31



IKS


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


20 1500000000103 KLINIK SUMBER SEHAT JALAN KAPTEN TANDEAN BLOK D 8 6574736 DR.IRENE HARTONO PER/46/2016 RS.TRAUMA CENTRE 10/05/2016 31/12/2016

21 1500000000103 KLINIK SUMBER SEHAT JALAN KAPTEN TANDEAN BLOK D 8 6574736 DR.IRENE HARTONO PER/15/012015 RS.TRAUMA CENTRE

01/02/2015 31/01/2016

22 1500000000182 KLINIK VITA MEDISTRA JL.PATTIMURA NO.11 KEC SIANTAR TIMUR 64731970 DR.JUNETA ZEBUA PER/46/052016 RS.TRAUMA CENTRE

10/05/2016 31/01/2017

23 1500000000182 KLINIK VITA MEDISTRA JL.PATTIMURA NO.11 KEC SIANTAR TIMUR 64731970 DR.JUNETA ZEBUA PER/17/022015 RS.TRAUMA CENTRE 01/02/2015 31/01/2016

24 1500000001813PT.PRIMA MEDICA NUSANTARA RS BALIMBINGAN

JL.KOMPLEK RS BALIMBINGAN KECAMATAN TANAH JAWA 21151 70829112 RS BALIMBINGAN

PER/49/TC/062016

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

25 1500000001813PT.PRIMA MEDICA NUSANTARA RS BALIMBINGAN

JL.KOMPLEK RS BALIMBINGAN KECAMATAN TANAH JAWA

21151 70829112 RS BALIMBINGAN PER/ 25/072015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

26 1500000001814 PT.PRIMA MEDICA NUSANTARA RS LARAS

JL. BESAR PEKAN BAHAPAL KECAMATAN BANDAR HULUAN

21151 081260963170

RS LARAS PER/48/TC/062016

RS.TRAUMA CENTRE

01/07/2016 31/12/2016

27 1500000001814PT.PRIMA MEDICA NUSANTARA RS LARAS

JL. BESAR PEKAN BAHAPAL KECAMATAN BANDAR HULUAN 21151

081260963170 RS LARAS PER/ 24 /072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

28 1500000001815PT.PRIMA MEDICA NUSANTARA RS PABATU

JL. DESA KEDAI DAMAR KECAMATAN TEBING TINGGI RS PABATU PER/23 /072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

29 1500000001815PT.PRIMA MEDICA NUSANTARA RS PABATU

JL. DESA KEDAI DAMAR KECAMATAN TEBING TINGGI

RS PABATU PER/47/062016RS.TRAUMA CENTRE

30/06/2016 31/12/2016

30 1400000000535 RSUD PERDAGANGAN JL.RAJAMIN PURBA ,SH PERDAGANGAN 70324734 RSUD PERDAGANGAN PER/29/TC/012016

RS.TRAUMA CENTRE

13/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


38 / 44607-11-201606:23:31



IKS


31 1400000000676 RSUD PORSEA JL. RAJA SIPAKKO NAPITUPULU KEC. PORSEA 61245547 PEMERINTAH KAB. TOBA

SAMOSIRPER/30/TC/012016

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

32 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

33 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

34 1400000000289 RUMAH SAKIT TENTARA JL. GUNUNG SIMANUK MANUK NO. 6 434171 RUMAH SAKIT TENTARA PER/03/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

35 1400000000545 RUMAH SAKIT UMUM DAERAH PARAPAT

JL.KOL TPR SINAGA KEC.GIRSANG SIPANGAN BOLON 62054053 RSUD PARAPAT PER/32/TC/0120

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

36 1400000000343RUMAH 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

37 1500000000589 RUMAH SAKIT VITA INSANI JL. MERDEKA NO.329 22520 PT. VITA INSANI SENTRA MEDIKA


30/05/2016 31/12/2016

38 1500000000589 RUMAH SAKIT VITA INSANI JL. MERDEKA NO.329 22520 PT. VITA INSANI SENTRA MEDIKA


01/05/2015 30/04/2016

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


Periode : 01/01/2015 s/d 31/10/2016


39 / 44607-11-201606:23:31



IKS


2 1400000000608 BPS SARTIKA JL. BESAR NEGERI LAMA KECAMATAN BILAH HILIR KABUPATEN LABUHAN BATU

081264339055 MURSYID DALIMUNTE PER/18/122014 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

3 1500000000057 BPS VITA SERASI DUSUN I DESA PETATAL KEC TALAWI KAB BATUBARA 61311291 HAMZAH PER/01/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

4 1500000000057 BPS VITA SERASI DUSUN I DESA PETATAL KEC TALAWI KAB BATUBARA

61311291 HAMZAH PER/29/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

5 7-4221703396 KLINIK AIDO MARSADA DUSUN VI BANDAR PASIR MANDOGE 21262 DR. INDAH ARINA PURBA PER/06/072016 RS.TRAUMA CENTRE

01/08/2016 31/12/2017

6 1400000000109 KLINIK AMANAH JL. SEI SILAU TIMUR KEC. BUNTU PANE 7352111 DR. NURHIMSYAH JUNEDI NASUTION PER/25/122014 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

7 1400000000109 KLINIK AMANAH JL. SEI SILAU TIMUR KEC. BUNTU PANE 7352111DR. NURHIMSYAH JUNEDI NASUTION PER/29/122015

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

8 1400000000606 KLINIK AULIA DUSUN III DESA SEI SUKA DERAS (KEBUN KOPI) KEC. SEI SUKA KAB. BATUBARA

085297350468

RITA ADELINA PER/16/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

9 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

10 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

11 1400000000609 KLINIK CENTRAL MEDIKAJL. ACCESS ROAD INALUM DESA PAKAM RAYA KECAMATAN MEDANG DERAS KABUPATEN BATU BARA

082368310000 ZULKARNAEN PER/17/122014

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

12 1400000000607 KLINIK DEWI SARTIKAJL. BEDAGAI NO. 129 KOTAPINANG KECAMATAN KOTA PINANG KABUPATEN LABUHAN BATU SELATAN

081264339055

MURSYID DALIMUNTE PER/29/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

13 1400000000607 KLINIK DEWI SARTIKAJL. BEDAGAI NO. 129 KOTAPINANG KECAMATAN KOTA PINANG KABUPATEN LABUHAN BATU SELATAN

081264339055

MURSYID DALIMUNTE PER/19/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


40 / 44607-11-201606:23:31



IKS


14 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

15 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/21/122014

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

16 1400000000203 KLINIK HARUNJL. ACCESS ROAD INALUM DESA LALANG KEC. MEDANG DERAS 620213 HARUN PER/24/122014

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

17 1400000000714 KLINIK KESUMA BANGSAJL. LINTAS SUMATERA NO. 9 DUSUN I DESARAHUNING KECAMATAN RAHUNING KABUPATEN ASAHAN

085261585929 DRG ZANIYAR PER/20/122014

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

18 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

19 1400000000727 KLINIK MITRA SEHATJL. KARTINI NO. 195 KECAMATAN KOTA KISARAN BARAT KABUPATEN ASAHAN

08126286145


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

20 1400000000727 KLINIK MITRA SEHAT JL. KARTINI NO. 195 KECAMATAN KOTA KISARAN BARAT KABUPATEN ASAHAN

08126286145

DR PATAR MT PANJAITAN


01/01/2016 31/12/2016

21 7-4220481865 KLINIK PUTRA JAYA DESA AIR MERAH 21463 082304604886

H. ALWI IRAWAN RAMBE, SH


01/08/2016 31/12/2017

22 1400000000718 KLINIK RAKYATJL. SM RAJA UJUNG BANDAR KECAMATAN RANTAU SELATAN KABUPATEN LABUHAN BATU

08126286145


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

23 1400000000718 KLINIK RAKYATJL. SM RAJA UJUNG BANDAR KECAMATAN RANTAU SELATAN KABUPATEN LABUHAN BATU

08126286145

DR PATAR MT PANJAITAN PER/22/122014 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

24 1500000000677 KLINIK SAUDARAJL. UTAMA NO. 90 B WONOSARI III KEL. AEK KANOPAN KEC. KUALUH HULU KAB. LABUHAN BATU UTARA

082272368299

KLINIK SAUDARA PER/05/042015RS.TRAUMA CENTRE

22/04/2015 31/12/2015

25 1500000000129 MITRA KLINIK DR H AHYAR RANGKUTI

DUSUN 1C DESA KAMPUNG PAJAK KEC NA IX-X

HALIMAH SARI RANI MARPAUNG


01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


41 / 44607-11-201606:23:31



IKS


26 1500000000129 MITRA KLINIK DR H AHYAR RANGKUTI

DUSUN 1C DESA KAMPUNG PAJAK KEC NA IX-X

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

CENTRE 01/01/2016 31/12/2016

27 1500000000662 PUSKESMAS INDRAPURA JL. JENDRAL SUDIRMAN NO. 63 BATUBARA 081376616429 PUSKESMAS INDRAPURA PER/29/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

28 1500000000662 PUSKESMAS INDRAPURA JL. JENDRAL SUDIRMAN NO. 63 BATUBARA 081376616429

PUSKESMAS INDRAPURA PER/04/042015 RS.TRAUMA CENTRE

16/04/2015 31/12/2015

29 1500000000663 PUSKESMAS KEDAI SIANAMJL. H.MUHAMMAD ZEIN DESA KEDAI SIANAM KEC. LIMA PULUH KAB. BATU BARA

081361449866

PUSKESMAS KEDAI SIANAM


16/04/2015 31/12/2015

30 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

31 1500000000665PUSKESMAS LABUHAN RUKU

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

081362061445

PUSKESMAS LABUHAN RUKU PER/04/042015

RS.TRAUMA CENTRE 16/04/2015 31/12/2015

32 1500000000665 PUSKESMAS LABUHAN RUKU

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

081362061445

PUSKESMAS LABUHAN RUKU


01/01/2016 31/12/2016

33 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

34 1500000000675 PUSKESMAS LALANGJL. ACCES ROAD INALUM DESA LALANG KEC. MEDANG DERAS KAB. BATU BARA PUSKESMAS LALANG PER/04/042015

RS.TRAUMA CENTRE 16/04/2015 31/12/2015

35 1500000000676 PUSKESMAS LAUTADOR KEC. LAUTADOR KAB. BATU BARA PUSKESMAS LAUTADOR PER/29/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

36 1500000000676 PUSKESMAS LAUTADOR KEC. LAUTADOR KAB. BATU BARA PUSKESMAS LAUTADOR PER/04/042015RS.TRAUMA CENTRE

16/04/2015 31/12/2015

37 1500000000666 PUSKESMAS LIMA PULUHJL. PERINTIS KEMERDEKAAN NO.73 KEL. LIMA PULUH KEC. LIMA PULUH KAB. BATU BARA

PUSKESMAS LIMA PULUH


01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


42 / 44607-11-201606:23:31



IKS


38 1500000000666 PUSKESMAS LIMA PULUHJL. PERINTIS KEMERDEKAAN NO.73 KEL. LIMA PULUH KEC. LIMA PULUH KAB. BATU BARA

PUSKESMAS LIMA PULUH PER/04/042015 RS.TRAUMA

CENTRE 16/04/2015 31/12/2015

39 1500000000667 PUSKESMAS PAGURAWAN JL. SUDIRMAN NO.149 KEL.P.DODEK KEC. MEDANG DERAS KAB. BATU BARA

PUSKESMAS PAGURAWAN PER/04/042015 RS.TRAUMA

CENTRE 16/04/2015 31/12/2015

40 1500000000667 PUSKESMAS PAGURAWAN JL. SUDIRMAN NO.149 KEL.P.DODEK KEC. MEDANG DERAS KAB. BATU BARA

PUSKESMAS PAGURAWAN


01/01/2016 31/12/2016

41 1500000000668 PUSKESMAS PEMATANG PANJANG

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

08126470444

PUSKESMAS PEMATANG PANJANG


16/04/2015 31/12/2015

42 1500000000668 PUSKESMAS PEMATANG PANJANG

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

08126470444

PUSKESMAS PEMATANG PANJANG PER/29/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

43 1500000000669 PUSKESMAS PETATALJL. LINTAS SUMATERA KM. 131 PETATAL KEC. TALAWI KAB. BATU BARA

085275999784 PUSKESMAS PETATAL PER/04/042015

RS.TRAUMA CENTRE 16/04/2015 31/12/2015

44 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

45 1500000000670 PUSKESMAS SEI BALAI JL.PERINTIS KEMERDEKAAN DESA SEI BALAI KEC.SEI BALAI KAB. BATU BARA

082360571537

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

01/01/2016 31/12/2016

46 1500000000670 PUSKESMAS SEI BALAIJL.PERINTIS KEMERDEKAAN DESA SEI BALAI KEC.SEI BALAI KAB. BATU BARA

082360571537 PUSKESMAS SEI BALAI PER/04/042015

RS.TRAUMA CENTRE 16/04/2015 31/12/2015

47 1500000000671 PUSKESMAS SEI SUKAJL.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

48 1500000000671 PUSKESMAS SEI SUKAJL.LINTAS SUMATERA DESA SEI SUKA DERAS KEC.SEI SUKA KAB. BATU BARA

PUSKESMAS SEI SUKA PER/04/042015RS.TRAUMA CENTRE

16/04/2015 31/12/2015

49 1500000000672 PUSKESMAS SIMPANG DOLOK

DUSUN I DESA SIMPANG DOLOK KAB. BATU BARA

081361063456

PUSKESMAS SIMPANG DOLOK


01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


43 / 44607-11-201606:23:31



IKS


50 1500000000672 PUSKESMAS SIMPANG DOLOK

DUSUN I DESA SIMPANG DOLOK KAB. BATU BARA

081361063456

PUSKESMAS SIMPANG DOLOK PER/04/042015 RS.TRAUMA

CENTRE 16/04/2015 31/12/2015

51 1500000000673 PUSKESMAS TANJUNG TIRAM

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

081264222800

PUSKESMAS TANJUNG TIRAM PER/04/042015 RS.TRAUMA

CENTRE 16/04/2015 31/12/2015

52 1500000000673 PUSKESMAS TANJUNG TIRAM

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

081264222800

PUSKESMAS TANJUNG TIRAM


01/01/2016 31/12/2016

53 1500000000674 PUSKESMAS UJUNG KUBU JL. BESAR UJUNG KUBU DUSUN IV KAB. BATU BARA

081361006865

PUSKESMAS UJUNG KUBU


16/04/2015 31/12/2015

54 1500000000674 PUSKESMAS UJUNG KUBU JL. BESAR UJUNG KUBU DUSUN IV KAB. BATU BARA

081361006865

PUSKESMAS UJUNG KUBU PER/29/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

55 1400000000294 RS SETIO HUSODOJL. SISINGAMANGARAJA NO. 67 KEL. KISARAN TIMUR KEC. KOTA KISARAN TIMUR

21214 44999 MARDI PER/30/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

56 1400000000294 RS SETIO HUSODOJL. SISINGAMANGARAJA NO. 67 KEL. KISARAN TIMUR KEC. KOTA KISARAN TIMUR

21214 44999 MARDI PER/26/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

57 1500000001895 RSU AVICENNAJL. LINTAS SUMATERA SIMPANG SIRANGGONG DAMULI PEKAN KABUPATENLABUHANBATU UTARA

7672018 TOSIP TANJUNG PER/07/082015 RS.TRAUMA CENTRE

03/08/2015 31/12/2015

58 1500000001895 RSU AVICENNAJL. LINTAS SUMATERA SIMPANG SIRANGGONG DAMULI PEKAN KABUPATENLABUHANBATU UTARA

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

59 7-4221793017 RSU ELPI AL AZIS JL. WR. SUPRATMAN RANTAU PRAPAT 214110624326061

DR. ERIK ADTRADA RITONGA PER/07/072016

RS.TRAUMA CENTRE 01/08/2016 31/12/2017

60 1500000001235 RSU TIGA BERSAUDARAJL. SIMONIS DUSUN I A DESA KAMPUNG PAJAK KECAMATAN NA IX-X

081360103239

DR M LATIF SITUMORANG


04/06/2015 31/12/2015

61 1500000001235 RSU TIGA BERSAUDARA JL. SIMONIS DUSUN I A DESA KAMPUNG PAJAK KECAMATAN NA IX-X

081360103239

DR M LATIF SITUMORANG


01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


44 / 44607-11-201606:23:31



IKS


62 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

63 1400000000468 RSU WIRA HUSADA JL. KARTINI NO. 209 KEL. SENDANG SARI KEC. KOTA KISARAN BARAT 42532 DR. DIAH JULIANA NST PER/27/122014 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

64 1500000000541 RSUD KABUPATEN BATU BARA

JL. DATUK KWALA GUNUNG KECAMATAN LIMA PULUH KABUPATEN BATU BARA

RSUD KABUPATEN BATUBARA


16/01/2015 31/12/2015

65 1500000000541 RSUD KABUPATEN BATU BARA

JL. DATUK KWALA GUNUNG KECAMATAN LIMA PULUH KABUPATEN BATU BARA

RSUD KABUPATEN BATUBARA


01/01/2016 31/12/2016

66 7-4901383835 RUMAH SAKIT UMUM NURAINI JALINSUM BLOKSONGO KOTA PINANG 21464 062449588

3 DR. YUSNAR YUSUP PER/08/092016 RS.TRAUMA CENTRE 22/09/2016 31/12/2017

KANTOR CABANG : B03- KANTOR CABANG PADANG SIDEMPUAN


IKS


1 1500000000532BALAI PENGOBATAN INSANI

JL MEDAN PADANG DESA AEK MUAL KEC.SIABU

RIANI HARNAS NASUTION PER/39/042015

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

2 1500000000259 DR ADE KURNIAWATHYJL DESA RIANIATE I KEC MUARA BATANGTORU 60280900 DR ADE KURNIAWATHY PER/31/032015

RS.TRAUMA CENTRE 01/03/2015 31/12/2015

3 06041 DR YUDIKA KRISTIANA JL. YOS SUDARSO NO. 160081376630933

DR YUDIKA KRISTIANA ZENDRATO


05/04/2016 31/12/2016

4 7-4957612733 KLINIK AL-KHOIR DESA MENANTI SOSA JAE KECAMATAN HUTARAJA TINGGI

22774 IBU ERNI PER/40/082016 RS.TRAUMA CENTRE

27/09/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


45 / 44607-11-201606:23:31



IKS


5 1500000000179 KLINIK ANANDA JL SIBOLGA-BARUS KM 25 KEL KOLANG NAULI LAMSERIA NABABAN PER/28/122014 RS.TRAUMA

CENTRE 01/02/2015 31/12/2015

6 1500000000185 KLINIK DAFFA JL SUDIRMAN LINGKUNGAN I PASAR SIBUHUAN

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

CENTRE 24/03/2016 31/12/2016

7 1500000000185 KLINIK DAFFA JL SUDIRMAN LINGKUNGAN I PASAR SIBUHUAN

DR ELNI RUBIANTI DAULAY


01/01/2015 31/12/2015

8 7-4958786676 KLINIK ERNI JL. PROF. HM. YAMIN PSR SIBUHUAN KEC. BARUMUN PADANG LAWAS

22763 ERNI ASFIATI HASIBUAN PER/39/082016 RS.TRAUMA CENTRE

29/09/2016 31/12/2017

9 1400000000584 KLINIK HARAPAN BUNDA JL ELANG NO 35 KELURAHAN AEK MANIS 361450301 HJ NURSYAM PER/13/122014 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

10 1400000000584 KLINIK HARAPAN BUNDA JL ELANG NO 35 KELURAHAN AEK MANIS 361450301 HJ NURSYAM PER/11/022016RS.TRAUMA CENTRE 24/03/2016 31/12/2016

11 1400000000585 KLINIK MEDICA JL MANGARAJA BATANG PANE NO 56 GUNUNG TUA

396746406 DR.HJ.ZUNAIDAH HASANAH M.KES


01/01/2015 31/12/2015

12 1400000000585 KLINIK MEDICA JL MANGARAJA BATANG PANE NO 56 GUNUNG TUA

396746406 DR.HJ.ZUNAIDAH HASANAH M.KES


24/03/2016 31/12/2016

13 1500000000392 KLINIK RIZKYJL DESA HAPESONG BARU KEC.BATANG TORU

DR MELVA ARWITA LUBIS PER/35/032015

RS.TRAUMA CENTRE 01/03/2015 31/03/2015

14 1500000000316PRAKTEK DOKTER DIAN ASPASIA LIMBONG JL NUSA INDAH NO 21 PADANG SIDIMPUAN 63595343

DR DIAN ASPASIA LIMBONG PER/13/02016

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

15 1500000000316PRAKTEK DOKTER DIAN ASPASIA LIMBONG

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


01/03/2015 31/12/2015

16 1500000000221 PRAKTEK DOKTER ELISA LIE

KELURAHAN WEK III BATANGTORU TAPANULI SELATAN

59236760 ELISA LIE PER/29/022015 RS.TRAUMA CENTRE

01/03/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


46 / 44607-11-201606:23:31



IKS


17 1400000000579 PRAKTEK DOKTER H LIGAM MA'ARUF LUBIS

JL ABDULLAH UMAR NO 1 KAYU JATI PANYABUNGAN 61652465 DR H.LIGAM MA'ARUF

LUBIS PER/14/122014 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

18 1400000000581 PRAKTEK DOKTER MARULI TUA SILALAHI JL OSWALD SIAHAAN NO 36 DR MARULI TUA

SILALAHI PER/16/122014 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

19 1400000000583 PRAKTEK DOKTER RIKKY N HARAHAP

JL R SUPRAPTO NO 70 SIBOLGA 62646523 DR RIKKY N HARAHAP PER/10/022016 RS.TRAUMA CENTRE

24/03/2016 31/12/2016

20 1400000000583 PRAKTEK DOKTER RIKKY N HARAHAP

JL R SUPRAPTO NO 70 SIBOLGA 62646523 DR RIKKY N HARAHAP PER/11/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

21 1500000000643 PRAKTEK DOKTER SEMPAKATA KABAN

JL PADANG SIDEMPUAN NO 20 B KM.9 PANDAN DR SEMPAKATA KABAN PER/43/022015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

22 1500000000644PRAKTEK DOKTER SRI FARIDA LESTARI HUTAHAEAN

JL SM RAJA NO 28 LING II PASAR BARU PO MANDUAMAS

DR.SRI FARIDA LESTARI HUTAHAEAN PER/42/042015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

23 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

24 1400000000580 PRAKTEK DOKTER SRI PRIHATIN K N HARAHAP

JL LINTAS GUNUNGTUA-LANGGA PAYUNG DESA SIHOPUK BARU

DR SRI PRIHATIN K N HARAHAP


01/01/2015 31/12/2015

25 1400000000578PRAKTEK DOKTER SRI WAHYUNI

JL SULTAN HASANUDDIN NO 30 PADANG SIDIMPUAN 6455987 DR SRI WAHYUNI PER/15/122014

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

26 1400000000578PRAKTEK DOKTER SRI WAHYUNI

JL SULTAN HASANUDDIN NO 30 PADANG SIDIMPUAN 6455987 DR SRI WAHYUNI PER/09/022016

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

27 1500000000393PRAKTEK DOKTER SYAMSIDAR

DESA MENANTI SOSA KEC.HUTARAJA TINGGI

DR SYAMSIDAR PER/36/032015RS.TRAUMA CENTRE

01/03/2015 31/12/2015

28 1500000000689 PRAKTEK DOKTER YUDIKA KRISTIANA

JL YOSSUDARSO NO 160 GUNUNGSITOLI DR YUDIKA KRISTIANA PER/40/042015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


47 / 44607-11-201606:23:31



IKS


29 1500000000689 PRAKTEK DOKTER YUDIKA KRISTIANA JL YOSSUDARSO NO 160 GUNUNGSITOLI DR YUDIKA KRISTIANA PER/29/042016 RS.TRAUMA

CENTRE 12/04/2016 31/12/2016

30 1500000000178 PRAKTEK DR ASRIAL JL SM RAJA NO 200 PADANGSIDIMPUAN DR ASRIAL PER/14/022016 RS.TRAUMA CENTRE 03/03/2016 31/12/2016

31 1500000000178 PRAKTEK DR ASRIAL JL SM RAJA NO 200 PADANGSIDIMPUAN DR ASRIAL PER/27/022015 RS.TRAUMA CENTRE

01/02/2015 31/12/2015

32 1500000000177 PRAKTEK DR MEINI BASYARIAH

JL MERDEKA NO 49 KECAMATAN SIPIROK DR MEINI BASYARIAH PER/25/012015 RS.TRAUMA CENTRE

01/02/2015 31/12/2015

33 1400000000688 PUSKESMAS AEK HABIL JL MERPATI NO 58 SIBOLGA SELATAN DR HOTMAULI HUTAGALUNG MKES PER/23/122014 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

34 1400000000690 PUSKESMAS PAROMBUNAN SAHAT D HUTAJULU PER/23/122014RS.TRAUMA CENTRE 01/01/2015 31/12/2015

35 1400000000689 PUSKESMAS PELABUHAN SAMBAS

JL HORAS UJUNG NO 171 SIBOLGA SAMBAS DR IVONNA HASFIKA PER/23/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

36 1400000000686 PUSKESMAS PINTU ANGIN JL OSWALD SIAHAAN NO 53 SIBOLGA UTARA

HOTMAULI MANIK SKM PER/23/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

37 1400000000687 PUSKESMAS SAMBAS JL TONGKOL NO 11 SIBOLGA KOTA DR JULIATI SISKA PER/23/122014RS.TRAUMA CENTRE 01/01/2015 31/12/2015

38 1400000000186 RS METTA MEDIKA JL SUTOYO SISWOMIHARJO NO 34 SIBOLGA 25007 PT METTA MEDIKA PER/15/032016RS.TRAUMA CENTRE 10/03/2016 31/12/2016

39 1400000000186 RS METTA MEDIKA JL SUTOYO SISWOMIHARJO NO 34 SIBOLGA 25007 PT METTA MEDIKA PER/12/122014RS.TRAUMA CENTRE

01/01/2015 31/12/2015

40 1500000000746 RSU BETHESDA JL DIPONEGORO NO 360 F KM 3 DESA SAIFALAETE TABALOHO

323316 DR YORIEN SETIA ALFARIANTI LASE


01/05/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


48 / 44607-11-201606:23:31



IKS


41 1500000000477 RSU PERMATA MADINA PANYABUNGAN

JL MERDEKA NO 155 PANYABUNGAN KAB MANDAILING NATAL 20279 DR H SAFII

SIREGAR,SPOG PER/22/032016 RS.TRAUMA CENTRE 25/04/2016 31/12/2016

42 1500000000477 RSU PERMATA MADINA PANYABUNGAN

JL MERDEKA NO 155 PANYABUNGAN KAB MANDAILING NATAL 20279 DR H SAFII

SIREGAR,SPOG PER/37/032015 RS.TRAUMA CENTRE 01/04/2015 31/12/2015

43 1500000000690 RSU PERMATA MADINA SIBUHUAN

JL KIHAJAR DEWANTARA 421060 DR.MUSBAR PER/38/042015 RS.TRAUMA CENTRE

01/04/2015 31/12/2015

44 1500000000690 RSU PERMATA MADINA SIBUHUAN

JL KIHAJAR DEWANTARA 421060 DR.MUSBAR PER/19/032016 RS.TRAUMA CENTRE

24/03/2016 31/12/2016

45 7-2830687153 RSUD PADANGSIDIMPUAN JL F L TOBING NO 10 22711 PEMERINTAH KOTA PADANGSIDIMPUAN PER/25/032016 RS.TRAUMA

CENTRE 07/04/2016 31/12/2016

46 1400000000683 RSUD PANDAN DR FERDINAND LUMBAN TOBING NO 5 PER/24/122014RS.TRAUMA CENTRE 01/01/2015 31/12/2015

47 1400000000683 RSUD PANDAN DR FERDINAND LUMBAN TOBING NO 5 PER/26/032016 RS.TRAUMA CENTRE

24/03/2016 31/12/2016

48 1400000000576 RSUD PANYABUNGAN JL MERDEKA NO 40 KAYU JATI PANYABUNGAN

20181 PER/19/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

49 1400000000344 RSUD SIBUHUAN JL KI HAJAR DEWANTARA SIBUHUAN 421678 PEMDA PER/18/032016RS.TRAUMA CENTRE 24/03/2016 31/12/2016

50 1400000000344 RSUD SIBUHUAN JL KI HAJAR DEWANTARA SIBUHUAN 421678 PEMDA PER/22/122014RS.TRAUMA CENTRE 01/01/2015 31/12/2015

51 1500000000176 RSUD TAPANULI SELATAN JL RUMAH SAKIT SIPIROK PEMERINTAH PER/26/022015RS.TRAUMA CENTRE

01/02/2015 31/12/2015

52 1500000000260 RUMAH SAKIT TK IV 01.07.03 JL JEND SUDIRMAN NO 1 KAB TAPANULI SELATAN

BAGINDA HARAHAP PER/20/032016 RS.TRAUMA CENTRE

24/03/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


49 / 44607-11-201606:23:31



IKS


53 1500000000260 RUMAH SAKIT TK IV 01.07.03 JL JEND SUDIRMAN NO 1 KAB TAPANULI SELATAN BAGINDA HARAHAP PER/32/032015 RS.TRAUMA

CENTRE 01/03/2015 31/12/2015

54 1400000000586 RUMKITBAN 01.08.02 SIBOLGA JL ANGGREK NO 6 SIBOLGA 362180265 RUMKITBAN PER/20/122014 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

KANTOR CABANG : B04- KANTOR CABANG TANJUNG MORAWA


IKS


1 1500000001892BALAI PENGOBATAN HOMBING

JL. SUDIRMAN NO. 148 NO. 148 DOLOK MASIHUL

085260446061

DR. JANNES E. SIHOMBING PER/36/082015

RS.TRAUMA CENTRE 01/08/2015 31/12/2015

2 1500000001892 BALAI PENGOBATAN HOMBING

JL. SUDIRMAN NO. 148 NO. 148 DOLOK MASIHUL

085260446061

DR. JANNES E. SIHOMBING


07/01/2016 31/12/2016

3 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

4 1400000000619 BPS KULON PROGOJL. BATANG KUIS GG. KANDAR NO. 8 DS TELAGA SARI TANJUNG MORAWA 7942321 DR. ARSYAD PER/33/072015

RS.TRAUMA CENTRE 01/07/2015 31/12/2015

5 1400000000033 BPS KURNIA SEHATJL. JEND SUDIRMAN LK.02 (DEPAN RS SRI PAMELA) TAN ERFI PER/14/012016

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

6 1400000000033 BPS KURNIA SEHATJL. JEND SUDIRMAN LK.02 (DEPAN RS SRI PAMELA)

TAN ERFI PER/05/012015RS.TRAUMA CENTRE

01/01/2015 31/12/2015

7 1400000000031 BPS MORAWA JL. MEDAN-LUBUK PAKAM KM. 17 7942361 TAN ERFI PER/16/012016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


50 / 44607-11-201606:23:31



IKS


8 1400000000031 BPS MORAWA JL. MEDAN-LUBUK PAKAM KM. 17 7942361 TAN ERFI PER/07/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

9 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

10 1400000000412 KLINIK 24 JAM DR. IRVAN DALIMUNTHE

JL. SOEKARNO-HATTA NO. 6 LINGKUNGAN IV PERUMAHAN TAMBANG PERMAI INDAH

23443444 DR. IRVAN DALIMUNTHE PER/19/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

11 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

12 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

13 1400000000405 KLINIK ARDIFARMA JAYAJL. STASIUN DSN II KP. KELING KEC. SEI RAMPAH 441543 DR. DINI ZURIANA PER/18/052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

14 1400000000037 KLINIK HAMIDAH JL.MEDAN-TJ.MORAWA KM 18,5 GG. PRIBADI

7945983 DIAN SARI PER/04/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

15 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

16 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

17 1400000000404KLINIK PRATAMA AFIYAH AMPLAS

JL. PANGLIMA DENAI KOMPLEKS RUKO AMPLAS BLOK A NO. 5 80019975

DRS. H. ARENA TRI JAYA GINTING, MM PER/20/052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

18 1500000001880 KLINIK PRATAMA ESSIVAJL. PASAR VII NO. 16 DESA TEMBUNG KEC. PERCUT SEI TUAN

20351 7380666 DR. JHONES R. SIPAYUNG PER/24/012016RS.TRAUMA CENTRE

07/01/2016 31/12/2016

19 1500000001880 KLINIK PRATAMA ESSIVA JL. PASAR VII NO. 16 DESA TEMBUNG KEC. PERCUT SEI TUAN

20351 7380666 DR. JHONES R. SIPAYUNG PER/35/072015 RS.TRAUMA CENTRE

01/08/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


51 / 44607-11-201606:23:31



IKS


20 1500000000070 KLINIK PRATAMA KULON PROGO BANGUN SARI

JL. MEDAN-TJ.MORAWA DESA BANGUN SARI

085275246273

DR. MUHAMMAD ARSHAD PER/27/062015 RS.TRAUMA

CENTRE 01/07/2015 31/12/2015



085275246273

DR. MUHAMMAD ARSHAD PER/23/012016 RS.TRAUMA

CENTRE 07/01/2016 31/12/2016



085275246273

DR. MUHAMMAD ARSHAD


01/01/2015 30/06/2015

23 1400000000590 KLINIK PRATAMA MANNA JL. PERTAHANAN NO. 98 PATUMBAK DR. JHONI SINAGA PER/21/012016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016

24 1400000000590 KLINIK PRATAMA MANNA JL. PERTAHANAN NO. 98 PATUMBAK DR. JHONI SINAGA PER/28/062015 RS.TRAUMA CENTRE 01/07/2015 31/12/2015

25 1500000001879 KLINIK PRATAMA MARSJALAN GALANG DUSUN IA NO. 121 DESA PURWODADI KEC. PAGAR MERBAU 20351 7952511 MARHEN, AMK PER/34/072015

RS.TRAUMA CENTRE 01/08/2015 31/12/2015

26 1500000001879 KLINIK PRATAMA MARS JALAN 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

27 1500000000069 KLINIK PRATAMA PAKAM JL. MEDAN NO. 38 A LUBUK PAKAM 08126523815

DR. MUSA TOGI MARPAUNG


01/07/2015 31/12/2015

28 1500000000069 KLINIK PRATAMA PAKAM JL. MEDAN NO. 38 A LUBUK PAKAM08126523815

DR. MUSA TOGI MARPAUNG PER/08/02015

RS.TRAUMA CENTRE 01/01/2015 30/06/2015

29 1500000000069 KLINIK PRATAMA PAKAM JL. MEDAN NO. 38 A LUBUK PAKAM08126523815

DR. MUSA TOGI MARPAUNG PER/22/012016

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

30 7-1242107043 KLINIK PUJAJL. BESAR PETUMBUKAN NO. 12 DS PETUMBUKAN KEC. GALANG

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

08/01/2016 31/12/2016

31 7-1239985383 KLINIK RAIHAN MENTENG INDAH BLOK B1 NO. 29 MEDAN 20228 081265410449

DR.DRG SUCI ERAWATI M.KES


08/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


52 / 44607-11-201606:23:31



IKS


32 1400000000032 KLINIK TUTUN SEHATI JL. PASAR BARU KM 17 TJ.MORAWA A NO.2 7945676 SALMIAH ZAKARIA PER/06/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

33 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

34 1400000000706 PUSKESMAS ARAS KABU DESA ARAS KABU KEC. BERINGIN 082167926514


07/01/2016 31/12/2016

35 1400000000719 PUSKESMAS BANDAR BARU DESA BANDAR BARU KEC. BANDAR BARU 081397941999

PER/27/01/2016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016

36 1400000000721 PUSKESMAS BANDAR DOLOK

DESA BANDAR DOLOK KEC. BANDAR DOLOK

081376670815 PER/27/012016 RS.TRAUMA

CENTRE 07/01/2016 31/12/2016

37 1400000000709PUSKESMAS BANDAR KHALIPAH

DESA BANDAR KHALIPAH KEC. PERCUT SEITUAN

081362408181 PER/27/012016

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

38 1400000000682 PUSKESMAS BANGUN PURBA

DESA BANGUN PURBA KEC. BANGUN PURBA

085262706056


08/01/2016 31/12/2016

39 1400000000707 PUSKESMAS BATANG KUIS BATANG KUIS KEC. BATANG KUIS 08126540600


08/01/2016 31/12/2016

40 1400000000681 PUSKESMAS BIRU-BIRU DESA BIRU-BIRU KEC. BIRU-BIRU081262175005 PER/27/012016

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

41 1400000000693 PUSKESMAS DALU SEPULUH DESA DALU X KEC. BERINGIN081376077435 PER/27/012016

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

42 1400000000698 PUSKESMAS DELI TUA DESA DELI TUA KEC. PATUMBAK08126432015


08/01/2016 31/12/2016

43 1400000000684 PUSKESMAS GALANG JL. BUKIT BARISAN GALANG KOTA KEC. GALANG

08126587680


08/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


53 / 44607-11-201606:23:31



IKS


44 1400000000703 PUSKESMAS GUNUNG MERIAH

DESA GUNUNG MERIAH KEC. GUNUNG MERIAH

081397999343 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

45 1400000000711 PUSKESMAS HAMPARAN PERAK

DESA HAMPARAN PERAK KEC. HAMPARANPERAK

082160351011 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

46 1400000000722 PUSKESMAS KARANG ANYER

DESA KARANG ANYER KEC. KARANG ANYER

081272118888


08/01/2016 31/12/2016

47 1400000000720 PUSKESMAS KENANGAN DESA KENANGAN KEC. PERCUT SEI TUAN 085358348281


08/01/2016 31/12/2016

48 1400000000723 PUSKESMAS KOTA DATAR DESA KOTA DATAR KEC. KOTA DATAR 082164747266 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

49 1400000000726 PUSKESMAS KUTALIMBARU DESA KUTALIMBARU KEC. KUTALIMBARU081361326400 PER/27/012016

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

50 1400000000710 PUSKESMAS LABUHAN DELI DESA LABUHAN DELI KEC. LABUHAN DELI 081269230222


08/01/2016 31/12/2016

51 1400000000705 PUSKESMAS LUBUK PAKAM JL. DIPONEGORO GG. WAKAF KEC. LUBUK PAKAM

085276730440


08/01/2016 31/12/2016

52 1400000000697 PUSKESMAS MULIOREJO DESA MULIOREJO KEC. SUNGGAL081375333643 PER/27/012016

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

53 1400000000699 PUSKESMAS NAMORAMBE DESA NAMORAMBE KEC. NAMORAMBE081264262444 PER/27/012016

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

54 1400000000704 PUSKESMAS PAGAR JATI DESA PAGAR JATI KEC. LUBUK PAKAM08126588410


08/01/2016 31/12/2016

55 1500000000029 PUSKESMAS PANCUR BATU DESA PANCUR BATU KEC. PANCUR BATU 082168463332


08/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


54 / 44607-11-201606:23:31



IKS


56 1400000000700 PUSKESMAS PANTAI LABU DESA PANTAI LABU KEC. PANTAI LABU 081263587546 PER/27/01/2016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

57 1400000000694 PUSKESMAS PATUMBAK DESA PATUMBAK KEC. PATUMBAK 085275960879 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

58 1500000000030 PUSKESMAS PEMATANG JOHAR

DESA PEMATANG JOHAR KEC.PEMATANG JOHAR

082160580199


08/01/2016 31/12/2016

59 1500000000031 PUSKESMAS PETUMBUKAN DESA PETUMBUKAN KEC. PETUMBUKAN 08126415151


08/01/2016 31/12/2016

60 1400000000724 PUSKESMAS SEI MENCIRIM DESA SEI MENCIRIM KEC. SUNGGAL 081370221459 PER/27/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

61 1400000000702 PUSKESMAS SEI SEMAYANGJL. SEI MENCIRIM GG. PUSKESMAS KEC. SUNGGAL

08116075420 PER/27/012016

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

62 1400000000680 PUSKESMAS SIBOLANGIT DESA SIBOLANGIT KEC. SIBOLANGIT 08126420297


08/01/2016 31/12/2016

63 1400000000725 PUSKESMAS SUKARAYA DESA SUKARAYA KEC. SUKARAYA 08126501329


08/01/2016 31/12/2016

64 1400000000701 PUSKESMAS TALUN KENAS DESA TALUN KENAS KEC. TALUN KENAS081375190502 PER/27/012016

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

65 1400000000685PUSKESMAS TANJUNG MORAWA

KEL. TANJUNG MORAWA PEKAN KEC. TANJUNG MORAWA

081375253099 PER/27/012016

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

66 1400000000708 PUSKESMAS TANJUNG REJODESA TANJUNG REJO KEC. PERCUT SEI TUAN

081264209777


08/01/2016 31/12/2016

67 1400000000678 PUSKESMAS TIGA JUHAR DESA TIGA JUHAR KEC. STM HULU 081265818732


08/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


55 / 44607-11-201606:23:31



IKS


68 1500000000205 RS BHAYANGKARA TK.III TEBING TINGGI JL. PAHLAWAN NO. 17 TEBING TINGGI POLRI RI PER/14/022015 RS.TRAUMA

CENTRE 01/02/2015 31/01/2017

69 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

70 1400000000030 RS GRAND MEDISTRA JL. MEDAN-LUBUK PAKAM KM.25 NO. 66 7955114 DRS. JOHANNES S PER/03/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

71 1500000001957 RS MORAWA UTAMA JL. MEDAN - TJ.MORAWA KM. 18,5 20351 7945058 PT. MORAWA UTAMA PER/40/092015 RS.TRAUMA CENTRE

01/09/2015 31/12/2015

72 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

73 1400000000589 RS PATAR ASIHJL. BAKARAN BATU DSN MANGGIS NO. 45 DESA TUMPATAN BERINGIN 7950449

NATANIEL P. NAINGGOLAN, SH PER/06/012016

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

74 1400000000589 RS PATAR ASIH JL. BAKARAN BATU DSN MANGGIS NO. 45 DESA TUMPATAN BERINGIN

7950449 NATANIEL P. NAINGGOLAN, SH


01/07/2015 31/12/2015

75 1500000001981 RS SRI PAMELA JL. JEND. SUDIRMAN NO. 299 20613 24748 PT. SRI PAMELA MEDIKA NUSANTARA


07/01/2016 31/12/2016

76 1500000001981 RS SRI PAMELA JL. JEND. SUDIRMAN NO. 299 20613 24748PT. SRI PAMELA MEDIKA NUSANTARA PER/37/092015

RS.TRAUMA CENTRE 01/10/2015 31/12/2015

77 1400000000038 RSU DR.GL TOBING PTPN II JL.RAYA MEDAN-TJ.MORAWA KM 16,5 20362 7944796 PTPN II (PERSERO) PER/01/012015RS.TRAUMA CENTRE 01/01/2015 31/12/2015

78 1400000000038 RSU DR.GL TOBING PTPN II JL.RAYA MEDAN-TJ.MORAWA KM 16,5 20362 7944796 PTPN II (PERSERO) PER/01/012016RS.TRAUMA CENTRE

07/01/2016 31/12/2016

79 1400000000035 RSU HERNA JL. BALAI KOTA NO. 2 21476 DR. DJOHAN ZEIN PER/02/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


56 / 44607-11-201606:23:31



IKS


80 1400000000035 RSU HERNA JL. BALAI KOTA NO. 2 21476 DR. DJOHAN ZEIN PER/02/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

81 1400000000622 RSU MELATI PERBAUNGAN JL. DELI NO. 105-115 PERBAUNGAN 7990056 DR. TONDY PER/25/062015 RS.TRAUMA CENTRE 01/07/2015 31/12/2015

82 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

83 1400000000587 RSU MITRA SEHAT JL. SEI MERAH NO. 300 DESA DAGANG KERAWANG

77607489 DR. SUSI, MKT PER/23/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

84 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

85 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

86 1400000000620 RSU SARI MUTIARA LUBUK PAKAM

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


01/07/2015 31/12/2015

87 1500000000099 RSU SEMBIRING DELI TUA JL. BESAR NO. 77 DELI TUA 7030802 DRS. JOHANNES S PER/26/062015 RS.TRAUMA CENTRE

01/07/2015 31/12/2015

88 1500000000099 RSU SEMBIRING DELI TUA JL. BESAR NO. 77 DELI TUA 7030802 DRS. JOHANNES S PER/10/012015RS.TRAUMA CENTRE 01/01/2015 30/06/2015

89 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

90 1500000000248 RSUD DELI SERDANG JL. THAMRIN LUBUK PAKAM 7952068 PEMKAB DELI SERDANG PER/09/012016RS.TRAUMA CENTRE

08/01/2016 31/12/2016

91 1500000000248 RSUD DELI SERDANG JL. THAMRIN LUBUK PAKAM 7952068 PEMKAB DELI SERDANG PER/12/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


57 / 44607-11-201606:23:31



IKS


92 1500000000204 RSUD SULTAN SULAIMAN JL. NEGARA KM 58 NO. 315 SEI RAMPAH PEMKAB SERDANG BEDAGAI PER/13/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

93 1500000000204 RSUD SULTAN SULAIMAN JL. NEGARA KM 58 NO. 315 SEI RAMPAH PEMKAB SERDANG BEDAGAI PER/10/012016 RS.TRAUMA

CENTRE 08/01/2016 31/12/2016

KANTOR CABANG : B05- KANTOR CABANG MEDAN BELAWAN


IKS


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

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

2 1500000000054 BALAI PENGOBATAN DELIMA

JL.MEDAN BELAWAN KM 21.5 MEDAN NURDELIMA SIHOMBING PER/24/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

3 1500000000053 KLINIK AZIZI JL.TEMPULING NO.111 A MEDAN DR.ANITAWATI PER/29/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

4 1500000000053 KLINIK AZIZI JL.TEMPULING NO.111 A MEDAN DR.ANITAWATI PER/05/2015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

5 1500000001219 KLINIK BINA SEJAHTERA JL.K.L YOS SUDARSO NO.68 DISIPLIN ROSALINA G PER/08/042015RS.TRAUMA CENTRE 01/05/2015 31/12/2015

6 1500000001219 KLINIK BINA SEJAHTERA JL.K.L YOS SUDARSO NO.68 DISIPLIN ROSALINA G PER/09/2015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

7 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


Periode : 01/01/2015 s/d 31/10/2016


58 / 44607-11-201606:23:31



IKS


8 1400000000331 KLINIK CITRA MEDIKA JL.PLATINA RAYA NO.58 MEDAN DR.YUDA PRAYOGI PER/25/122014 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

9 1500000000231 KLINIK DANDY JALAN RUMAH POTONG HEWAN NO.15 A 20241 66516974 SITI HAWA MANAO PER/26/122014 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

10 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

11 1500000000250 KLINIK HAJI KRAKATAU JALAN KRAKATAU NO.48 A/110 MEDAN TAKBIR SIREGAR PER/04/022015 RS.TRAUMA CENTRE

01/03/2015 31/12/2015

12 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

13 1500000000251KLINIK HAJI MEDAN PANCING

JALAN WILLIEM ISKANDAR /PANCING NO.100 C TAKBIR SIREGAR PER/10/2015

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

14 1500000000251 KLINIK HAJI MEDAN PANCING

JALAN WILLIEM ISKANDAR /PANCING NO.100 C

TAKBIR SIREGAR PER/03/022015 RS.TRAUMA CENTRE

01/03/2015 31/12/2015

15 1500000000052 KLINIK HELVETIA III JL.KL YOS SUDARSO SP.KANTOR TEGUH SUHARTO PER/23/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

16 1500000000052 KLINIK HELVETIA III JL.KL YOS SUDARSO SP.KANTOR TEGUH SUHARTO PER/06/2015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

17 1500000000051 KLINIK HELVETIA VIII JL.KL YOS SUDARSO KM 20,5 MEDAN TEGUH SUHARTO,SE PER/07/2015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

18 1500000000051 KLINIK HELVETIA VIII JL.KL YOS SUDARSO KM 20,5 MEDAN TEGUH SUHARTO,SE PER/22/122014RS.TRAUMA CENTRE

01/01/2015 31/12/2015

19 1500000000459 KLINIK MUTIARA KOTA BANGUN

JL KL YOS SUDARSO KM 10.5 20241 96333303 NURHAYATI PURBA PER/05/032015 RS.TRAUMA CENTRE

01/04/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


59 / 44607-11-201606:23:31



IKS


20 1500000000459 KLINIK 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

21 7-1919381394 KLINIK PRATAMA HARAPANSEHAT SEJAHTERA

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

CENTRE 05/02/2016 31/12/2016

22 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

23 7-3913683793 KLINIK PRATAMA PRIMA MELATI

JL KL YOS SUDARSO NO 43 20111 SRI WAHYUNI NASUTION PER/07/062016 RS.TRAUMA CENTRE

23/06/2016 31/12/2016

24 7-3300073231 KLINIK QYTA MEDIKA JL KAPTEN RAHMAD BUDIN LINGKUNGAN 13 KELURAHAN TERJUN 20111 CHELLIA PER/03/052016 RS.TRAUMA

CENTRE 12/05/2016 31/12/2016

25 1400000000332 KLINIK TIMUR JAYA JL.KL.YOS SUDARSO KM 10,6 MEDAN DR.KURNIAWAN PER/21/122014RS.TRAUMA CENTRE 01/01/2015 31/12/2015

26 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

27 1500000000289 PUSKESMAS BELAWAN JL MEDAN BELAWAN 4520331 DINKES KOTA MEDAN PER/01/022015 RS.TRAUMA CENTRE

24/02/2015 23/02/2020

28 1500000000287 PUSKESMAS BINJAI JL. M. NAWI HARAHAP MEDAN DINKES KOTA MEDANPER/01/022015.03

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

29 1500000000288 PUSKESMAS BROMO JL BROMO DINKES KOTA MEDANPER/01/022015.02

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

30 1500000000286 PUSKESMAS DENAI JL DENAI MEDAN DINKES KOTA MEDANPER/01/022015.04

RS.TRAUMA CENTRE

24/02/2015 23/02/2020

31 1500000000311 PUSKESMAS DESA TERJUN JL.KL YOS SUDARSO MEDAN 4520331 DR.SURYA SYAHPUTRA PULUNGAN

PER/01/022015.11

RS.TRAUMA CENTRE

24/02/2015 23/02/2020


Periode : 01/01/2015 s/d 31/10/2016


60 / 44607-11-201606:23:31



IKS


32 1500000000285 PUSKESMAS GLUGUR DARAT JL PENDIDIKAN MEDAN DINKES KOTA MEDAN PER/01/022015.0

5RS.TRAUMA CENTRE 24/02/2015 23/02/2020

33 1500000000283 PUSKESMAS GLUGUR KOTA JL KL YOS SUDARSO 6942329 DINKES KOTA MEDAN PER/01/022015.07

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

34 1500000000284 PUSKESMAS MANDALA JL CUCAK RAWA MEDAN 7351781 DINKES KOTA MEDAN PER/01/022015.06

RS.TRAUMA CENTRE

24/02/2015 23/02/2020

35 1500000000312 PUSKESMAS MARTUBUNG JL.MARTUBUNG 4520331 DR,NURAISYAH HASIBUAN


01/02/2015 31/01/2020

36 1500000000304 PUSKESMAS MEDAN AREA SELATAN JL.MEDAN AREA SELATAN 4520331 DR.LININIATY DAELY PER/01/022015.1

8RS.TRAUMA CENTRE 24/02/2015 23/02/2020

37 1500000000303 PUSKESMAS MEDAN DELI 4520331 DR.NURLELINPER/01/022015.19

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

38 1500000000282 PUSKESMAS MEDAN LABUHAN

JL KL YOS SUDARSO SP KANTOR MEDAN 6856738 DINKES KOTA MEDAN PER/01/022015.08

RS.TRAUMA CENTRE

24/02/2015 23/02/2020

39 1500000000308 PUSKESMAS PB SERING JL.SERING MEDAN TEMBUNG 4520331 DR.REFRINI PER/01/022015.14

RS.TRAUMA CENTRE

24/02/2015 23/02/2020

40 1500000000281PUSKESMAS PEKAN LABUHAN JL KL YOS SUDARSO KM 18.5 6856738 DINKES KOTA MEDAN

PER/01/022015.09

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

41 1500000000306 PUSKESMAS PULO BRAYAN JL.KL YOS SUDARSO 4520331 NURAISYAH HASIBUANPER/01/022015.16

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

42 1500000000305 PUSKESMAS SEI AGUL JL.KEMIRI MEDAN 4520331 DRG IVA PURNAMAPER/01/022015.17

RS.TRAUMA CENTRE

24/02/2015 23/02/2020

43 1500000000310 PUSKESMAS SENTOSA BARU JL.SENTOSA BARU MEDAN 4520331 DR.SYARIFAH HANUM PER/01/022015.12

RS.TRAUMA CENTRE

24/02/2015 23/02/2020


Periode : 01/01/2015 s/d 31/10/2016


61 / 44607-11-201606:23:31



IKS


44 1500000000307 PUSKESMAS TEGAL SARI JL.RAWA CANGKUK MEDAN 4520331 ERNA SARI PER/01/022015.15

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

45 1500000000309 PUSKESMAS TITI PAPAN JL.PLATINA IV NO.10 MEDAN 4520331 DR.ERNA SARI PER/01/022015.13

RS.TRAUMA CENTRE 24/02/2015 23/02/2020

46 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

47 1400000000336 RS MARTHA FRISKA JALAN KL YOS SUDARSO NO.91 MEDAN RASIN BBA,MHA PER/19/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

48 1400000000455 RSU MITRA MEDIKA JL KL YOS SUDARSO KM 7.5 TJ MULIA DR. HANIFAH, M. KES PER/27/122014 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

49 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

50 1400000000335 RUMAH SAKIT IMELDA JALAN BILAL NO.24 P.BRAYAN DR.IMELDA LIANA RITONGA


01/01/2015 31/12/2015

51 1400000000335 RUMAH SAKIT IMELDA JALAN BILAL NO.24 P.BRAYAN DR.IMELDA LIANA RITONGA


01/01/2016 31/12/2016

52 7-3299717470RUMAH SAKIT METHODIST MEDAN JALAN M H THAMRIN NO 105 20115

0617369000

DR HENDRA W DJUANG MARS PER/04/052016

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

53 1400000000334RUMAH SAKIT PELABUHAN BELAWAN JL.STASIUN NO.92 BELAWAN 6941927

PT.PELABUHAN INDONESIA PER/12/2015

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

54 1400000000334RUMAH SAKIT PELABUHAN BELAWAN

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


01/01/2015 31/12/2015

55 1500000000452 RUMAH SAKIT TK II PUTRI HIJAU

JALAN PUTRI HIJAU NO.17 MEDAN PER/10/062016 RS.TRAUMA CENTRE

29/06/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


62 / 44607-11-201606:23:31



IKS


56 1500000000452 RUMAH SAKIT TK II PUTRI HIJAU JALAN PUTRI HIJAU NO.17 MEDAN PER/07/042015 RS.TRAUMA

CENTRE 01/04/2015 31/12/2015

KANTOR CABANG : B06- KANTOR CABANG BINJAI


IKS


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

CENTRE 27/01/2016 31/12/2016

2 1500000000922 KLINIK ADISMA HUSADAJL TANJUNG PURA-PELAWI UTARA PANGKALAN BRANDAN DR KIKIE INDRIATY PER/32/062016

RS.TRAUMA CENTRE 14/07/2016 31/12/2016

3 1500000000922 KLINIK ADISMA HUSADA JL TANJUNG PURA-PELAWI UTARA PANGKALAN BRANDAN

DR KIKIE INDRIATY PER/04/052015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

4 1400000000210 KLINIK ADISMA MANDIRI JL MEDAN BINJAI KM 10.8 DESA PAYA GELISUNGGAL

DR BUDI JEFRI PER/08/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

5 1400000000210 KLINIK ADISMA MANDIRIJL MEDAN BINJAI KM 10.8 DESA PAYA GELISUNGGAL DR BUDI JEFRI PER/31/062016

RS.TRAUMA CENTRE 15/06/2016 31/12/2016

6 7-4357352003 KLINIK MELATI JL KAMPUNG TEMPEL BAHOROK 20774 61682821 JHON BINSAR KETAREN PER/33/062016RS.TRAUMA CENTRE 12/08/2016 31/12/2016

7 1400000000209 KLINIK MUTIARA DISKIJL BINJAI KM 12 DESA MULIOREJO KEC SUNGGAL

DRS WASHINGTON PER/017/082015RS.TRAUMA CENTRE

01/06/2015 31/12/2016

8 1500000001924 KLINIK PRATAMA SEHAT SEHATI

JL RAYA BINJAI KM 14.6 DISKII 20351 370139966 DR ELVII SUSANTI SITEPU


10/05/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


63 / 44607-11-201606:23:31



IKS


9 1500000001924 KLINIK PRATAMA SEHAT SEHATI JL RAYA BINJAI KM 14.6 DISKII 20351 370139966 DR ELVII SUSANTI

SITEPU PER/019/082015 RS.TRAUMA CENTRE 01/08/2015 31/12/2015

10 7-3471627403 KLINIK PRATAMA ANUGERAH JL SENTOSA NO 94 DESA MULYO REJO 20351 88235003 SUNDARI PER/26/052016 RS.TRAUMA

CENTRE 25/05/2016 31/12/2016

11 7-1958871584 KLINIK PRATAMA DOA IBU JL SUDIRMAN LINGK II SETIA NO 53 PERDAMAIAN

20811 H BUDIANTO WAHYU WARDOYO


10/02/2016 31/12/2016

12 7-3004856563 KLINIK PRATAMA DORARA JL SETIA AGUNG GG MAWAR I 20351 SUHAINI PER/19/042016 RS.TRAUMA CENTRE

25/04/2016 31/12/2016

13 7-3712480255 KLINIK PRATAMA PABERNA JL TANI ASLI NO 12 DESA TANJUNG GUSTA 20351 TIOMAN BR PASARIBU PER/28/05/16 RS.TRAUMA CENTRE 15/06/2016 31/12/2016

14 7-4977116037 KLINIK PRATAMA RIDHO JL PEMBANGUNAN NO 3 MULYOREJO 20351DR GOKLAS R.P TAMBUNAN PER/36/102016

RS.TRAUMA CENTRE 03/10/2016 31/12/2017

15 1500000000430 KLINIK PRATAMA SARI MUTIARA TANDEM

JL TANJUNG PURA NO 98 DESA TANDEM HILIR HAMPARAN PERAK

396880292 DR TUAHMAN PER/12/022016 RS.TRAUMA CENTRE

29/04/2016 31/12/2016

16 1500000000430 KLINIK PRATAMA SARI MUTIARA TANDEM

JL TANJUNG PURA NO 98 DESA TANDEM HILIR HAMPARAN PERAK

396880292 DR TUAHMAN PER/02/032015 RS.TRAUMA CENTRE

24/03/2015 23/03/2016

17 7-2570400503KLINIK PRATAMA SEMPURNA JL GATOT SUBROTO NO 335 20719 ESRA SEMBIRING PER/06/022016

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

18 7-3434901443KLINIK PRATAMA SUNARTIK DUSUN VII DESA SEI MENCIRIM SUNGGAL 20351 396661440 SUNARTIK PER/25/052016

RS.TRAUMA CENTRE 18/05/2016 31/12/2016

19 1500000000068 KLINIK PRIMA MEDIKA JL KH ZAINUL ARIFIN NO 1 A KEC STABAT MANGIHUT MARATUA PER/17/032016RS.TRAUMA CENTRE

04/06/2016 31/12/2016

20 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


Periode : 01/01/2015 s/d 31/10/2016


64 / 44607-11-201606:23:31



IKS


21 7-3713662806 PRAKTEK BERSAMA JL PERINTIS BARU KEL PURWODADI 20351 DR JYMMI NAINGGOLAN PER/27/052016 RS.TRAUMA CENTRE 15/06/2016 31/12/2016

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

23 1500000000213 RS BANGKATAN PTPN II JL SULTAN HASANUDDIN NO 40 BINJAI 75080063 PTPN II PER/01/022015 RS.TRAUMA CENTRE

18/02/2015 31/01/2016

24 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

25 7-3434330623 RS PERTAMINA P. BRANDAN JL WAHIDIN NO 1 PANGKALAN BRANDAN 20881 0620322612

PT PERTAMINA BINA MEDICA PER/24/052016 RS.TRAUMA

CENTRE 18/05/2016 31/12/2016

26 7-4477851773 RS RACHMAD INSANI JL PERNIAGAAN NO 36 STABAT BARU 20811 RACMAD SUWELEN PER/34/082016RS.TRAUMA CENTRE 26/08/2016 31/12/2016

27 7-3866312651 RS SURYA JL K H ZAINUL ARIFIN NO 8 STABAT BARU 20811 DR FADEL SITEPU PER/002/062016 RS.TRAUMA CENTRE

21/06/2016 31/12/2016

28 1500000001203 RSIA SYLVANI JL PERINTIS KEMERDEKAAN NO 21 LK V KEL PAHLAWAN

80045925 DR SUGIANTO PER/06/052015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

29 7-2048054644 RSU ARTHA MEDICA BINJAI JL SAMANHUDI NO 22 BINJAI 20711 ARUSTA TARIGAN PER/08/022016RS.TRAUMA CENTRE 17/02/2016 31/12/2016

30 7-2030604103 RSU BIDADARI JL. PERINTIS KEMERDEKAAN NO 147 BINJAI 20744 FIRMANSYAH SE MARS PER05/022016RS.TRAUMA CENTRE 16/02/2016 31/12/2016

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

15/03/2016 31/12/2016

32 1500000001944 RSU FULL BETHESDA JL BINJAI KM 10.8 GG SAMA NO 71 SUNGGAL

20351 65570210 SARMA HARO PER/29/052016 RS.TRAUMA CENTRE

01/07/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


65 / 44607-11-201606:23:31



IKS


33 1500000001944 RSU FULL BETHESDA JL BINJAI KM 10.8 GG SAMA NO 71 SUNGGAL 20351 65570210 SARMA HARO PER/015/072015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

34 1500000001820 RSU FULL BETHESDA JL BINJAI KM 10.8 / JL SAMA NO 71 SUNGGAL 20351 8457573 SARMA HARO PER/015/072015 FFS 01/07/2015 30/06/2016

35 1500000000429 RSU KELIAT JL SULTAN ARAB NO 111 DESA KLUMPANG KAMPUNG HAMPARAN PERAK

PRATEN NATALIA BR KELIAT


25/03/2015 24/03/2016

36 1500000000429 RSU KELIAT JL SULTAN ARAB NO 111 DESA KLUMPANG KAMPUNG HAMPARAN PERAK

PRATEN NATALIA BR KELIAT


04/05/2016 31/12/2016

37 7-2047722993 RSU LATERSIA JL SOEKARNO HATTA NO 451 20731 ROBINSON SEMBIRING PER/07/022016 RS.TRAUMA CENTRE 17/02/2016 31/12/2016

38 7-3113910618 RSU RATU MAS JL T AMIR HAMZAH NO 281 A 20744PT ROYA L MEDIKA RAYA PER/20/0416

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

39 1500000001925 RSU RESTU IBU JL JENDRAL GATOT SUBROTO KM 8.5 NO 434 MEDAN

20111 8451638 PER/018/082015 RS.TRAUMA CENTRE

03/08/2015 31/12/2016

40 7-4516254963 RSUD DJOELHAM BINJAI JL SULTAN HASANUDDIN NO 9 BINJAI 20711 PEMERINTAH PER/35/082016 RS.TRAUMA CENTRE

26/08/2016 31/12/2016

41 7-2446378422 RSUD TANJUNG PURA JL KHAIRIL ANWAR TANJUNG PURA 20853 PEMERINTAH PER/15/032016RS.TRAUMA CENTRE 10/03/2016 31/12/2016

KANTOR CABANG : B23- KABUPATEN NIAS


Periode : 01/01/2015 s/d 31/10/2016


66 / 44607-11-201606:23:31



IKS


1 7-3063241293 KLINIK PRATAMA SEHAT JL LAGUNDRI NO 57 GUNUNGSITOLI 22811 MANY PER/28/042016 RS.TRAUMA CENTRE 25/04/2016 31/12/2016

KANTOR CABANG : C00- KANTOR CABANG PADANG


IKS


1 7-885661125 RS SEMEN PADANG JL. BY PASS KM 7 KEL PISANG KEC PAUH 25161 YAYASAN RS SEMEN PADANG PER/40/092015 RS.TRAUMA

CENTRE 08/12/2015 31/12/2016

2 1500000001953KLINIK AISYIYAH II KAMPUNG PERAK JL. SM JAMIL KAMPUNG PERAK 25511 92544 PER/31/082015

RS.TRAUMA CENTRE 01/09/2015 31/12/2016

3 1500000001955 KLINIK AISYIYAH III JL PADANG BUKITTINGGI SIMPANG LINTASLUBUK ALUNG


01/09/2015 31/12/2016

4 1500000001939 KLINIK AMANAH JL. RAYA PADANG BUKITTINGGI KM 19 DUKU KEC. BATANG ANAI

25552 481291 EDISON SKM MKES PER/34/082015 RS.TRAUMA CENTRE

01/09/2015 31/12/2016

5 1400000000040 KLINIK ARUM SARI JL SUTAN SYAHRIL NO.332081363474133 DR FERI MULYANI PER/05/012015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

6 1400000000040 KLINIK ARUM SARI JL SUTAN SYAHRIL NO.332081363474133 DR FERI MULYANI PER/44/122015

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

7 1500000001984 KLINIK FANISAJL. KAPTEN PIERE TENDEAN NO 4 KAMPUNG BARU

25511 93205 DR YULFI ANETA PER/39/092015RS.TRAUMA CENTRE

01/10/2015 31/12/2016

8 1500000001970 KLINIK FITRIA JL. BY PASS KM 6 SIMPANG PARAK KARAKAH

25161 775322 DR. HJ. AUMAS PABUTI, SPA, MARS


01/10/2015 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


67 / 44607-11-201606:23:31



IKS


9 1500000001871 KLINIK INTAN SARI JL DR H ABDULLAH AHMAD NO 13 01/01 SAWAHAN PADANG TIMUR 25112 DR MARTHA EDDYWATI PER/26/072015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

10 1500000000954 KLINIK INTRO MEDIKA JL H AGUS SALIM NO 19 811150 NURMIDALMI, SE PER/20/042016 RS.TRAUMA CENTRE 04/05/2016 31/12/2017

11 1500000000954 KLINIK INTRO MEDIKA JL H AGUS SALIM NO 19 811150 NURMIDALMI, SE PER/15/052015 RS.TRAUMA CENTRE

04/05/2015 03/05/2016

12 1500000001941 KLINIK MITRA SENDONA JL. DR SUTOMO NOMOR 85 KEL KUBU MARAPALAM

25111 CV ARSY HENDRAMA PER/33/082015 RS.TRAUMA CENTRE

01/09/2015 31/12/2016

13 7-3171683333 KLINIK PT. KSI JORONG SUNGAI TANGAH KENAGARIAN SUNGAI KUNYIT 27777 PT. KSI PER/23/052016 RS.TRAUMA

CENTRE 04/05/2016 31/12/2017

14 1500000000813 KLINIK SAMUDRA MEDIKA JL PALEMBANG NO 20 GAUNGANI GUSMELA DEWISKA S, SIT PER/07/022016

RS.TRAUMA CENTRE 04/05/2016 31/12/2016

15 1500000000813 KLINIK SAMUDRA MEDIKA JL PALEMBANG NO 20 GAUNG ANI GUSMELA DEWISKA S, SIT


04/05/2015 03/05/2016

16 1500000001025 KLINIK SIMPANG ANDURING

JL ANDALAS SIMPANG ANDURING NO 7 ANDURING KURANJI

PROF DR H ZULKARNAINARSYAD, SPPD-KP


06/06/2016 31/12/2017

17 1500000001025KLINIK SIMPANG ANDURING

JL ANDALAS SIMPANG ANDURING NO 7 ANDURING KURANJI

PROF DR H ZULKARNAINARSYAD, SPPD-KP PER/17/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

18 7-2810976383KLINIK TIN ISKANDAR MEDIKAL JL M YAMIN SH NO 21 KAMPUNG BARU 25511 67191675 H ISKANDAR AS PER/14/032016

RS.TRAUMA CENTRE 05/04/2016 31/12/2016

19 1500000001954 RS AISYIYAH PARIAMAN JL. ABDUL MUIS NOMOR 26 TARATAK 25511 92544PD AISYIYAH KOTA PARIAMAN


01/09/2015 31/12/2016

20 1500000000635 RS BHAYANGKARA PADANG

JL JATI NO 1 PADANG POLDA SUMBAR PER/11/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016


Periode : 01/01/2015 s/d 31/10/2016


68 / 44607-11-201606:23:31



IKS


21 1500000000635 RS BHAYANGKARA PADANG JL JATI NO 1 PADANG POLDA SUMBAR PER/05/022016 RS.TRAUMA

CENTRE 01/04/2016 31/12/2016

22 1500000000767 RS KHUSUS BEDAH KARTIKA DOCTA

JL. GAJAH MADA NO. 14 GUNUNG PANGILUN 4481278 H. MUSTAFA KAMAL PER/06/022015 RS.TRAUMA

CENTRE 01/04/2016 31/12/2016

23 1500000000767 RS KHUSUS BEDAH KARTIKA DOCTA

JL. GAJAH MADA NO. 14 GUNUNG PANGILUN

4481278 H. MUSTAFA KAMAL PER/12/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

24 7-4688568073 RS NAILI DBS JL RATULANGI NO.24 25114 PT. ANANDA NAILI PRIMA


09/09/2016 31/12/2017

25 1500000001054 RS SELAGURI JL JEND A. YANI NO 26 DR HJ HAFLEZIANI M.KES PER/18/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

26 1500000001054 RS SELAGURI JL JEND A. YANI NO 26DR HJ HAFLEZIANI M.KES PER/22/042016

RS.TRAUMA CENTRE 01/05/2016 31/12/2017

27 7-797923945 RS SITI RAHMAH JL. RAYA BY PASS KM. 15 AIE PACAH 25173 YAYASAN RSI SITI RAHMAH


04/12/2015 31/12/2016

28 1400000000039 RS TENTARA REKSODIWIRYO

JL DR WAHIDIN NO.1 PADANG 31003 DATASEMEN KESEHATAN


01/01/2015 31/12/2015

29 1400000000039RS TENTARA REKSODIWIRYO JL DR WAHIDIN NO.1 PADANG 31003

DATASEMEN KESEHATAN PER/45/122015

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

30 7-919921504 RSI IBNU SINA PADANG JL. GAJAH MADA KEL GUNUNG PANGILUN 25142YAYASAN RS ISLAM SUMATERA BARAT PER/43/122015

RS.TRAUMA CENTRE 18/12/2015 31/12/2016

31 7-2995836423RSJ PROF HB SAANIN PADANG

JL. RAYA ULU GADUT KEL LIMAU MANIS SELATAN

25161 PEMPROV SUMBAR PER/19/042016RS.TRAUMA CENTRE

21/04/2016 31/12/2016

32 1500000000955 RSUD DR M ZEIN PAINAN JL DR A RIVAI KOTA PAINAN 2142821518

PEMDA PESISIR SELATAN


04/05/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


69 / 44607-11-201606:23:31



IKS


33 1500000000955 RSUD DR M ZEIN PAINAN JL DR A RIVAI KOTA PAINAN 2142821518

PEMDA PESISIR SELATAN PER/13/052015 RS.TRAUMA

CENTRE 04/05/2015 03/05/2016

34 1500000001940 RSUD DR RASYDIN PADANG JL. SEI SAPIH KEC KURANJI 25231 PEMERINTAH KOTA PADANG PER/35/092015 RS.TRAUMA

CENTRE 01/09/2015 31/12/2016

35 7-2895404723 RSUD MENTAWAI JL. RAYA TUAPEJAT KM 9 KEC SIPORA UTARA

25392 PEMDA KAB KEP MENTAWAI


18/04/2016 31/12/2016

36 1500000001956 RSUD PADANG PARIAMAN JL. RAYA PADANG BUKITTINGGI KM 42 PARIT MALINTANG

PEMDA KAB PADANG PARIAMAN


01/09/2015 31/12/2016

37 1500000000914 RSUD PARIAMAN JL PROF M YAMIN SH NO 5 91118-91428 PEMPROV SUMBAR PER/16/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

38 1500000000914 RSUD PARIAMAN JL PROF M YAMIN SH NO 591118-91428 PEMPROV SUMBAR PER/18/042016

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

39 1500000001920 RSUP DR M DJAMIL PADANG JL. PERINTIS KEMERDEKAAN 25111 32371 PER/28/082015 RS.TRAUMA CENTRE

01/08/2015 31/12/2016

40 1500000000507 RUMAH SAKIT KHUSUS BEDAH ROPANASURI

JL. AUR NO. 8 PADANG 31938 DR. QUINTA SARI, SP. KK PER/03/022016 RS.TRAUMA CENTRE

01/04/2016 31/12/2016

41 1500000000507RUMAH SAKIT KHUSUS BEDAH ROPANASURI JL. AUR NO. 8 PADANG 31938 DR. QUINTA SARI, SP. KK PER/09/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

42 1500000000534RUMAH SAKIT UMUM BHAKTI KESEHATAN MASYARAKAT (BKM)

JLN JENDRAL SUDIRMAN SAGO KENAGARIAN SAGO-SALIDO KEC IV JURAI 63385109 MAWARDI PER/10/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

43 1500000000534RUMAH SAKIT UMUM BHAKTI KESEHATAN MASYARAKAT (BKM)

JLN JENDRAL SUDIRMAN SAGO KENAGARIAN SAGO-SALIDO KEC IV JURAI

63385109 MAWARDI PER/04/022016RS.TRAUMA CENTRE

01/04/2016 31/12/2016

44 7-5026296353 RUMAH SAKIT YOS SUDARSO PADANG

JALAN SITUJUH NOMOR 1 25121 DR. ERLIS BEBY JULIANTO

PER /30/092016 RS.TRAUMA CENTRE

10/10/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


70 / 44607-11-201606:23:31


KANTOR CABANG : C01- KANTOR CABANG BUKIT TINGGI


IKS


1 1500000001070 KLINIK ALIFJL LENGGOGENI NO 92, JORONG LANTAI BATU, NAGARI BARINGIN, LIMA KAUM, TANAH DATAR

EVA YULIA PER/010/052015 FFS 01/06/2015 31/12/2016

2 1500000001058 KLINIK AQILAHJL SOEKARNO HATTA KELURAHAN PAKAN SINAYAN, KECAMATAN PAYAKUMBUH BARAT

DR HJ MARISSA PER/06/052015 FFS 01/06/2015 31/12/2016

3 1500000001059 KLINIK DR H AGUNG MULIA MARS

PERUMAHAN PASAMAN BARU GARDEN BLOK L/4 JORONG KATIMAHA, NAGARI LINGKUANG AUA, KECAMATAN PASAMAN

DR H AGUNG MULIA MARS PER/09/052015 FFS 01/06/2015 31/12/2016

4 1500000001104 KLINIK KAYYASA ARIFIJL RAYA PADANG LUA-BUKITTINGGI KM 4, NAGARI PADANG LUA, KEC. BANUHAMPU, AGAM

HERMALIS PER/011/052015 FFS 01/06/2015 31/12/2016

5 1500000001949 KLINIK PRATAMA PT AMP PLANTATION

DESA TAPIAN KANDIS, KEC. PALEMBAYAN,KAB. AGAM

26151 PT AMP PLANTATION PER/013/092015 FFS 01/09/2015 31/08/2016

6 1500000001949 KLINIK PRATAMA PT AMP PLANTATION

DESA TAPIAN KANDIS, KEC. PALEMBAYAN,KAB. AGAM 26151 PT AMP PLANTATION PER/017/082016 RS.TRAUMA

CENTRE 01/09/2016 31/12/2017

7 1500000001161 PRAKTEK DR MARNIYANTIRAMBAH KINALI. JORONG IV KOTO, KEC. KINALI, PASAMAN BARAT DR MARNIYANTI PER/08/052015 FFS 01/06/2015 31/12/2016

8 1500000001050PRAKTEK DR SONYA THEMIARTO

JL IMAM BONJOL NO 280, KEL BALAI-BALAIPADANG PANJANG

DR SONYA THEMIARTO PER/05/052015 FFS 01/06/2015 31/05/2016

9 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

10 1400000000223 RSI IBNU SINA PAYAKUMBUH

JL PEMUDA NO 14 PAYAKUMBUH 92222 YARSI SUMATERA BARAT


01/01/2016 31/12/2016

11 1400000000239RSI IBNU SINA SIMPANG AMPEK

JL M. NATSIR PASAMAN BARU SIMPANG EMPAT PASAMAN BARAT 7464015

YAYASAN RUMAH SAKITISLAM SUMATERA BARAT

PER/016/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

12 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


Periode : 01/01/2015 s/d 31/10/2016


71 / 44607-11-201606:23:31



IKS


13 1500000000076 RSUD KOTA PADANG PANJANG

JL BARU TABEK GADANG GANTIANG KOTAPADANG PANJANG 82046 PEMDA PADANG

PANJANG PER/001/012015 RS.TRAUMA CENTRE 01/02/2015 31/12/2015

14 1500000000817 RSUD LUBUK BASUNG JL DR M HATTA, PADANG BARU, LUBUK BASUNG 76017 PEMDA AGAM PER/003/042015 FFS 01/05/2015 30/04/2017

15 1500000001169 UPTD BALAI LATIHAN KERJA PAYAKUMBUH

JALAN KAMBOJA NO 10 SEBERANG BETUNG PAYAKUMBUH

93632 DASWING SPD PER/07/052015 FFS 01/06/2015 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

2 1500000000548 BALAI LATIHAN KERJA KABUPATEN SOLOK

JL RAYA LUBUK SELASIH KM 01 KAYU ARO ZULFAKHRI,S.SOS PER/03/032015 FFS 02/03/2015 31/12/2015

3 1400000000099 BLUD-RSUD SAWAHLUNTO JL KARTINI NO 18 74066837 PER/07/122015RS.TRAUMA CENTRE 21/01/2016 31/12/2016

4 1400000000099 BLUD-RSUD SAWAHLUNTO JL KARTINI NO 18 74066837 PER/14/052015RS.TRAUMA CENTRE 01/05/2015 31/12/2015

5 1500000000749 KLINIK ALTHAF JL M YAMIN NO 83 DR.DINI ASTA DIANI PER/14/122015RS.TRAUMA CENTRE

21/01/2016 31/12/2016

6 1500000000749 KLINIK ALTHAF JL M YAMIN NO 83 DR.DINI ASTA DIANI PER/12/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


72 / 44607-11-201606:23:31



IKS


7 1500000000722 KLINIK ARBA NAGARI SUNGAI RUMBAI TIMUR KEC SUNGAI RUMBAI YUSNIMAR SST PER/09/052015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

8 1500000000722 KLINIK ARBA NAGARI SUNGAI RUMBAI TIMUR KEC SUNGAI RUMBAI YUSNIMAR SST PER/12/122015 RS.TRAUMA

CENTRE 05/01/2016 31/12/2016

9 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

10 1500000000761 KLINIK KURNIA JL DT PERPATIH NAN SABATANG KOTA SOLOK

EVAMAIROZA,SE,M.KES PER/13/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

11 1500000000948 KLINIK PRATAMA NURJINIS JL BUKIT BERBUNGA NAGARI SUNGAI RUMBAI TIMUR NURJINIS PER/13/122015 RS.TRAUMA

CENTRE 05/01/2016 31/12/2016

12 1500000000948 KLINIK PRATAMA NURJINISJL BUKIT BERBUNGA NAGARI SUNGAI RUMBAI TIMUR NURJINIS PER/10/052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

13 1500000000895 PUSKESMAS ALAHAN PANJANG

KEC LEMBAH GUMANTI KABUPATEN SOLOK


01/06/2015 31/12/2015

14 1500000000895 PUSKESMAS ALAHAN PANJANG

KEC LEMBAH GUMANTI KABUPATEN SOLOK


05/01/2016 31/12/2016

15 1500000000748 PUSKESMAS TALANGJL LINTAS SOLOK-PADANG KEC GUNUNG TALANG PER/08/052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

16 1500000000547RSUD AROSUKA KABUPATEN SOLOK

JL LINTAS SUMATERA AROSUKA KABUPATEN SOLOK

DR.I.NYOMAN ARDANA PUTRA PER/03/042015

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

17 1500000000547RSUD AROSUKA KABUPATEN SOLOK

JL LINTAS SUMATERA AROSUKA KABUPATEN SOLOK

DR.I.NYOMAN ARDANA PUTRA


21/01/2016 31/12/2016

18 1500000000464 RSUD SIJUNJUNG JL LINTAS SUMATRA KM 110 TANAH BADANTUANG


21/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


73 / 44607-11-201606:23:31



IKS


19 1500000000464 RSUD SIJUNJUNG JL LINTAS SUMATRA KM 110 TANAH BADANTUANG 20056 PER/01/032015 RS.TRAUMA

CENTRE 01/03/2015 31/12/2015

20 1400000000017 RSUD SOLOK SIMPANG RUMBIO KOTA SOLOK 20826 RSUD SOLOK PER/05/032015 RS.TRAUMA CENTRE 01/05/2015 31/12/2015

21 1400000000017 RSUD SOLOK SIMPANG RUMBIO KOTA SOLOK 20826 RSUD SOLOK PER/09/122015 RS.TRAUMA CENTRE

21/01/2016 31/12/2016

22 7-3723504814 RSUD SOLOK SELATAN JL RAYA KM 1 MUARO LABUH KAB SOLOK SELATAN

27775 DR MEDRI IDAMAN PER/01/052016 RS.TRAUMA CENTRE

10/06/2016 31/12/2016

23 1500000000466 RSUD SUNGAI DAREH JL LINTAS SUMATERA KM 2 PULAU PUNJUNG 40347 PER/02/032015 RS.TRAUMA

CENTRE 01/03/2015 31/12/2015

24 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


IKS


1 7-2918533335 AULIA HOSPITAL JL. HR SUBRANTAS NO. 63 28293 6700.000PT. PUTERI AULIA DITA MEDICA PER/09/042016

RS.TRAUMA CENTRE 18/04/2016 31/12/2016

2 7-129782961 FASKES HATI AKHIR SEPT JLN SEJAHTERA RAYA NO 5 10150 SUHESI MAHENDRA 112233 28/09/2015 31/12/2015

3 7-126189943 FASKES KOKOLATE NORA 11333 15/09/2015 16/12/2015


Periode : 01/01/2015 s/d 31/10/2016


74 / 44607-11-201606:23:31



IKS


4 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

5 1500000001877 KLINIK FELLITA JL. KAHARUDDIN NASUTION NO. 145-146 MAHARATU MARPOYAN DAMAI 28111 68401901 DR. YANTI FATMI, DK PER/35/072015 RS.TRAUMA

CENTRE 01/07/2015 31/12/2015

6 1500000001877 KLINIK FELLITA JL. KAHARUDDIN NASUTION NO. 145-146 MAHARATU MARPOYAN DAMAI

28111 68401901 DR. YANTI FATMI, DK PER/35/072015 RS.TRAUMA CENTRE

30/03/2016 31/12/2016

7 1500000001988 KLINIK FIDYA JL. LINTAS TIMUR - PASAR SOREK SATU 72026643 DR. IMAN RANDAL TARIGAN, SP.PD


30/03/2016 31/12/2016

8 1500000001988 KLINIK FIDYA JL. LINTAS TIMUR - PASAR SOREK SATU 72026643 DR. IMAN RANDAL TARIGAN, SP.PD PER/41/102015 RS.TRAUMA

CENTRE 05/10/2015 31/12/2015

9 1500000000301 KLINIK NAYAKA HUSADAJL H IMAM MUNANDAR NO 12 PEKANBARU KEC TANGKERANG SELATAN 28288 68015266

PT. NAYAKA ERA HUSADA PER/12/032015

RS.TRAUMA CENTRE 01/03/2015 28/02/2016

10 1500000000301 KLINIK NAYAKA HUSADA JL H IMAM MUNANDAR NO 12 PEKANBARU KEC TANGKERANG SELATAN

28288 68015266 PT. NAYAKA ERA HUSADA


21/07/2016 31/12/2016

11 1500000001878 KLINIK PELITA HATI JALAN RAYA TALUK KUANTAN DESA LUBUK SAKAT PERHENTIAN RAJA

28411 76892989 FEBRIAN CHASRA,SE.S.FILL


01/07/2015 31/12/2015

12 1500000001878 KLINIK PELITA HATIJALAN RAYA TALUK KUANTAN DESA LUBUK SAKAT PERHENTIAN RAJA 28411 76892989

FEBRIAN CHASRA,SE.S.FILL PER/37/072015

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

13 1500000000240 KLINIK PERAWANG MEDIKA KM 6 PERAWANG KEC TUALANG085364646865 DR M FAJAR HANAFI PER/07/032015

RS.TRAUMA CENTRE 01/03/2015 28/02/2016

14 1500000001770KLINIK PRATAMA BMC PEKANBARU

JL. PAUS NO. 32 F LIMBUNGAN BARU RUMBAI PESISIR

28262 05617614 ARMAINI, SH PER/31/062015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

15 1500000001770 KLINIK PRATAMA BMC PEKANBARU

JL. PAUS NO. 32 F LIMBUNGAN BARU RUMBAI PESISIR

28262 05617614 ARMAINI, SH PER/31/062015 RS.TRAUMA CENTRE

30/03/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


75 / 44607-11-201606:23:31



IKS


16 7-492772759 KLINIK PRATAMA CENDANA HUSADA JL. JATI NO. 76 SENAPELAN 28151 HJ. ELLIYANNORA PER/46/112015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

17 7-492772759 KLINIK PRATAMA CENDANA HUSADA JL. JATI NO. 76 SENAPELAN 28151 HJ. ELLIYANNORA PER/46/112015 RS.TRAUMA

CENTRE 27/11/2015 31/12/2015

18 7-4165331353 KLINIK PRATAMA DOKTER HERLI

JL. RAYA PEKANBARU-LIPAT KAIN KM 74 28471 DR. IRWAN HERLI PER/27/072016 RS.TRAUMA CENTRE

01/08/2016 31/12/2017

19 7-522122673 KLINIK PRATAMA TIFFANY MEDIKA

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

27/11/2015 31/12/2015

20 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

21 1400000000029 KLINIK RAUDAHJL ADI SUCIPTO NO.239 KEC SIDOMULYO TIMUR/MARPOYAN DAMAI 4881091 DR.GUSRIANTI PER/06/032015

RS.TRAUMA CENTRE 01/03/2015 28/02/2016

22 7-3527630615 KLINIK UTAMA BUDI MULYA

JL. MAHARAJA INDRA KM 6 28381 0761493380

DR. MULZIAH EFFENDI, MKES


27/05/2016 31/12/2016

23 7-4250318733 PRAKTEK DOKTER KELUARGA ERNA ARIYANI

JL. TENGKU BEY/UTAMA NO. 150 C 28288 DR. ERNA ARIYANI PER/28/072016 RS.TRAUMA CENTRE

04/08/2016 31/12/2017

24 1500000000243 RS AMALIA MEDIKAJL MAHARAJA INDRA NO 433 PANGKALAN KERINCI 95348 H UJANG MALIK SE PER/16/052016

RS.TRAUMA CENTRE 27/05/2016 31/12/2016

25 1500000000243 RS AMALIA MEDIKAJL MAHARAJA INDRA NO 433 PANGKALAN KERINCI 95348 H UJANG MALIK SE PER/09/032015

RS.TRAUMA CENTRE 01/03/2015 28/02/2016

26 1200000000002 RS AWAL BROS JL JENDRAL SUDIRMAN NO 117 47333 PT AWAL BROS PUTRA PER/14/042016RS.TRAUMA CENTRE

10/06/2016 31/12/2016

27 1400000000036 RS EFARINA JL.LINTAS TIMUR NO.1 494500 PT EFARINA PER/26/072016 RS.TRAUMA CENTRE

04/08/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


76 / 44607-11-201606:23:31



IKS


28 1400000000036 RS EFARINA JL.LINTAS TIMUR NO.1 494500 PT EFARINA PER/10/032015 RS.TRAUMA CENTRE 01/03/2015 28/02/2016

29 7-4073704793 RS JMB PEKANBARU JL. KHAYANGAN/SEKOLAH NO 53 28287 DR. AGO HARLIM, SP.BP PER/22/072016 RS.TRAUMA CENTRE 21/07/2016 31/12/2016

30 1200000000001 RS PROF DR TABRANI JL SUDIRMAN NO 410 35464 PROF. DR TRABRANI PER/18/042015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

31 1200000000001 RS PROF DR TABRANI JL SUDIRMAN NO 410 35464 PROF. DR TRABRANI PER/25/072016 RS.TRAUMA CENTRE

27/07/2016 31/12/2017

32 1400000000100 RS SYAFIRA JL JENDRAL SUDIRMAN NO 134 3061000 DR IRANA OKTAVIA PER/16/042015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

33 1400000000100 RS SYAFIRA JL JENDRAL SUDIRMAN NO 134 3061000 DR IRANA OKTAVIA PER/24/072016RS.TRAUMA CENTRE 27/07/2016 31/12/2017

34 1400000000100 RS SYAFIRA JL JENDRAL SUDIRMAN NO 134 3061000 DR IRANA OKTAVIA 13033896716 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

35 1500000000241 RSUD SIAK SRI INDRAPURA JL SEI KECIL KABUPATEN SIAK 20012 HJ.ULFAH HANUM PER/08/032015 RS.TRAUMA CENTRE

01/03/2015 28/02/2016

36 1500000000241 RSUD SIAK SRI INDRAPURA JL SEI KECIL KABUPATEN SIAK 20012 HJ.ULFAH HANUM PER/18/052016RS.TRAUMA CENTRE 10/06/2016 31/12/2016

37 7-791544013 RUMAH SAKIT A.YANI JL. JEND. A. YANI NO. 73 28115 076123954PT. PERDANA UTAMA MANDIRI PER/49/122015

RS.TRAUMA CENTRE 07/12/2015 31/12/2016

38 1500000001028 RUMAH SAKIT BINA KASIH JL. SAMANHUDI NO. 3-5 SENAPELAN 21718 DEWI KHUSNIATY PER/21/052015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

39 1500000001028 RUMAH SAKIT BINA KASIH JL. SAMANHUDI NO. 3-5 SENAPELAN 21718 DEWI KHUSNIATY PER/17/052016 RS.TRAUMA CENTRE

06/06/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


77 / 44607-11-201606:23:31



IKS


40 7-300282953 RUMAH SAKIT ISLAM IBNU SINA JL. MELATI NO. 60 28122 0761 24242 PT. SYIFA UTAMA PER/45/112015 RS.TRAUMA

CENTRE 27/11/2015 31/12/2015

41 7-300282953 RUMAH 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

42 1500000001341 RUMAH SAKIT PEKANBARU MEDICAL CENTER

JALAN LEMBAGA PEMASYARAKATAN NO. 25 GOBAH, PEKANBARU

848100 PT. PEKANBARU MEDIKAL SENTER


01/06/2015 31/12/2015

43 1500000001341 RUMAH SAKIT PEKANBARU MEDICAL CENTER

JALAN LEMBAGA PEMASYARAKATAN NO. 25 GOBAH, PEKANBARU

848100 PT. PEKANBARU MEDIKAL SENTER


30/03/2016 31/12/2016

44 7-5144133729 RUMAH SAKIT SANTA MARIA JL. JEND. A. YANI NO 68 28127 YAYASAN SALUS

INFIRMORUM PER/33/102016 RS.TRAUMA CENTRE 20/10/2016 31/12/2017

45 1500000000141RUMAH SAKIT TENTARA PEKANBARU JL KESEHATAN NO 1 PEKANBARU 22426 DR.YUDHI DORANDES PER/02/022015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

46 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

47 7-131427341 SATYA LENCANA JLN JOJO NO 2 10150 KOKO 12121111 RS.TRAUMA CENTRE

01/01/2015 02/10/2015

KANTOR CABANG : D01- KANTOR CABANG TANJUNG PINANG


IKS


1 1400000000014 BALAI PENGOBATAN TIARA MEDIKA

JL. TELUK SASAH TANJUNG UBAN 484427 DR ERIKA M KAMIL PER/57/022016 RS.TRAUMA CENTRE

04/03/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


78 / 44607-11-201606:23:31



IKS


2 1400000000014 BALAI PENGOBATAN TIARA MEDIKA JL. TELUK SASAH TANJUNG UBAN 484427 DR ERIKA M KAMIL PER/06/022015 RS.TRAUMA

CENTRE 24/02/2015 23/02/2016

3 1500000000461 KLINIK ANANDA JALAN D.I PANJAITAN KM 10 08127027685 KLINIK ANANDA PER/17/032015 RS.TRAUMA

CENTRE 26/03/2015 25/03/2016

4 1500000000461 KLINIK ANANDA JALAN D.I PANJAITAN KM 10 08127027685

KLINIK ANANDA PER/59/122015 RS.TRAUMA CENTRE

26/03/2016 31/12/2016

5 1500000001213 KLINIK AZZAHRA JL. HANG JEBAT KIJANG KLINIK AZZAHRA PER/35/042015 RS.TRAUMA CENTRE

27/04/2015 26/04/2016

6 1500000001213 KLINIK AZZAHRA JL. HANG JEBAT KIJANG KLINIK AZZAHRA PER/35/042015 RS.TRAUMA CENTRE 27/04/2015 26/04/2016

7 1500000001213 KLINIK AZZAHRA JL. HANG JEBAT KIJANG KLINIK AZZAHRA PER/35/042015RS.TRAUMA CENTRE 27/04/2015 26/04/2016

8 1500000001213 KLINIK AZZAHRA JL. HANG JEBAT KIJANG KLINIK AZZAHRA PER/66/2015 RS.TRAUMA CENTRE

27/04/2016 31/12/2016

9 1500000000924 KLINIK ERNES JL.PERMAISURI NO.08 TANJUNG UBAN KEPULAUAN RIAU

085265696020

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

01/05/2016 31/12/2016

10 1500000000924 KLINIK ERNESJL.PERMAISURI NO.08 TANJUNG UBAN KEPULAUAN RIAU

085265696020 DR.ODRI ANGNES T

01/05 / ERNES /2015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

11 1500000001281KLINIK ERNES PT. ALAM INDAH BINTAN JL. LOT 1-2-3 LAGOI DR. ODRI ANGNES T PER/44/062015

RS.TRAUMA CENTRE 11/06/2015 10/06/2016

12 1500000001281KLINIK ERNES PT. ALAM INDAH BINTAN

JL. LOT 1-2-3 LAGOI DR. ODRI ANGNES T PER/07/012016RS.TRAUMA CENTRE

11/06/2016 31/12/2016

13 1500000001280 KLINIK ERNES PT. BINTAN LAGOON RESORT

JL. INDERA SEGARA SITE A-12 LAGOI DR. ODRI ANGNES T PER/43/062015 RS.TRAUMA CENTRE

11/06/2015 10/06/2016


Periode : 01/01/2015 s/d 31/10/2016


79 / 44607-11-201606:23:31



IKS


14 1500000001280 KLINIK ERNES PT. BINTAN LAGOON RESORT JL. INDERA SEGARA SITE A-12 LAGOI DR. ODRI ANGNES T PER/08/012016 RS.TRAUMA

CENTRE 21/09/2016 31/12/2018

15 1500000001282 KLINIK MEDIKA YAKESPEN KIJANG JL. KESEHATAN NO.36 C DR. REZA FADILAH PER/45/062015 RS.TRAUMA

CENTRE 11/06/2015 10/06/2016

16 1500000001282 KLINIK MEDIKA YAKESPEN KIJANG

JL. KESEHATAN NO.36 C DR. REZA FADILAH PER09/012016 RS.TRAUMA CENTRE

21/09/2016 31/12/2018

17 1500000000439 KLINIK PARIWISATA LAGOI KAWASATAN WISATA LAGOI BINTAN . JL KOTA KAPUR

08127769269

KLINIK PARIWISATA LAGOI


21/09/2016 31/12/2018

18 1500000000439 KLINIK PARIWISATA LAGOI KAWASATAN WISATA LAGOI BINTAN . JL KOTA KAPUR

08127769269

KLINIK PARIWISATA LAGOI PER/13/032015 RS.TRAUMA

CENTRE 10/03/2015 09/03/2016

19 1500000001980KLINIK PRATAMA KIMIA FARMA D.I PANJAITAN JLN D.I PANJAITAN KM 9 TANJUNGPINANG 29112

KLINIK PRATAMA KIMIA FARMA D.I PANJAITAN PER/52/102015

RS.TRAUMA CENTRE 01/10/2015 31/12/2016

20 1500000001979 KLINIK PRATAMA KIMIA FARMA GANET

JLN GANET BLOK A NO 1-2 TANJUNGPINANG

KLINIK PRATAMA KIMIA FARMA GANET


01/10/2015 31/12/2015

21 1500000001979 KLINIK PRATAMA KIMIA FARMA GANET

JLN GANET BLOK A NO 1-2 TANJUNGPINANG

KLINIK PRATAMA KIMIA FARMA GANET


21/09/2016 31/12/2018

22 1500000001974KLINIK PRATAMA KIMIA FARMA M.T HARYONO JLN M.T HARYONO KM 3 TANJUNGPINANG 29113

KLINIK PRATAMA KIMIA FARMA M.T HARYONO PER/54/102015

RS.TRAUMA CENTRE 01/10/2015 31/12/2016

23 1500000001974KLINIK PRATAMA KIMIA FARMA M.T HARYONO JLN M.T HARYONO KM 3 TANJUNGPINANG 29113

KLINIK PRATAMA KIMIA FARMA M.T HARYONO PER/54/102015

RS.TRAUMA CENTRE 01/10/2015 31/12/2016

24 05338PPK-I RSUP KEPULAUAN RIAU - TG UBAN

JL INDUN SURI , TANJUNG UBAN 482655PEMERINTAH PROPINSI KEPRI


04/03/2016 31/12/2016

25 1500000000322 PRAKTEK DR. ERWIN BUNTORO

JL PERMAISURI TANJUNG UBAN DR. ERWIN BUNTORO PER/61/122015 RS.TRAUMA CENTRE

21/09/2016 31/12/2018


Periode : 01/01/2015 s/d 31/10/2016


80 / 44607-11-201606:23:31



IKS


26 00306 PRAKTEK DR. ERWIN BUNTORO JL PERMAISURI TANJUNG UBAN 081372490

663 DR. ERWIN BUNTORO PER / 61 / 122015

RS.TRAUMA CENTRE 09/03/2016 31/12/2016

27 1500000000322 PRAKTEK DR. ERWIN BUNTORO JL PERMAISURI TANJUNG UBAN DR. ERWIN BUNTORO PER/09/032015 RS.TRAUMA

CENTRE 09/03/2015 08/03/2016

28 1500000000825 PUSKESMAS BATU 10 JL. ADI SUCIPTO KM.10 KEL. BATU IX, KEC. TANJUNG PINANG TIMUR

PUSKESMAS BATU 10 PER/40/052015 RS.TRAUMA CENTRE

04/05/2015 03/05/2016

29 1500000000321 PUSKESMAS KAMPUNG BUGIS

JALAN ABDUL RAHIM KELURAHAN KAMPUNG BUGIS, TANJUNGPINANG

PUSKESMAS KAMPUNG BUGIS

PER/ 10 / 032015 RS.TRAUMA CENTRE

09/03/2015 08/03/2016

30 1500000000321 PUSKESMAS KAMPUNG BUGIS

JALAN ABDUL RAHIM KELURAHAN KAMPUNG BUGIS, TANJUNGPINANG

PUSKESMAS KAMPUNG BUGIS PER/62/122015 RS.TRAUMA

CENTRE 09/03/2016 31/12/2016

31 1500000001526 PUSKESMAS KAWAL JL. WISATA BAHARI KM 9PEMERINTAH KAB. BINTAN PER/10/012016

RS.TRAUMA CENTRE 21/09/2016 31/12/2018

32 1500000001526 PUSKESMAS KAWAL JL. WISATA BAHARI KM 9 PEMERINTAH KAB. BINTAN


15/06/2015 14/06/2016

33 1500000001716 PUSKESMAS KIJANG PUSKESMAS KIJANG 29132 61118 PUSKESMAS KIJANG PER/48/062015 RS.TRAUMA CENTRE

29/06/2015 28/06/2016

34 1500000001716 PUSKESMAS KIJANG PUSKESMAS KIJANG 29132 61118 PUSKESMAS KIJANG PER/11/012016RS.TRAUMA CENTRE 21/09/2016 31/12/2018

35 1500000000923 PUSKESMAS MEKAR BARU JL CENDERAWASIH KM 8 TANJUNGPINANG 7003559 RIAMA SARAGI PER/68/122015RS.TRAUMA CENTRE 01/05/2016 31/12/2016

36 1500000000923 PUSKESMAS MEKAR BARU JL CENDERAWASIH KM 8 TANJUNGPINANG 7003559 RIAMA SARAGIPER/400/186/5.6.11/052015

RS.TRAUMA CENTRE

01/05/2015 30/04/2016

37 1500000000638 PUSKESMAS MELAYU KOTA PIRING

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

PUSKESMAS MELAYU KOTA PIRING


27/04/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


81 / 44607-11-201606:23:31



IKS


38 1500000000638 PUSKESMAS MELAYU KOTA PIRING

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

PUSKESMAS MELAYU KOTA PIRING PER/34/042015 RS.TRAUMA

CENTRE 27/04/2015 26/04/2016

39 1500000001969 PUSKESMAS NUMBING KP GIN BESAR RT 001 RW 001 29132 PUSKESMAS NUMBING PER/56/102015 RS.TRAUMA CENTRE 01/10/2015 31/12/2016

40 1500000001969 PUSKESMAS NUMBING KP GIN BESAR RT 001 RW 001 29132 PUSKESMAS NUMBING PER/56/102015 RS.TRAUMA CENTRE

01/10/2015 31/12/2016

41 1500000000823 PUSKESMAS SEI JANG JL. ARIEF RAHMAN HAKIM KEL. SEI JANG, KEC. BUKIT BESTARI

26239 PUSKESMAS SEI JANG PER/38/052015 RS.TRAUMA CENTRE

04/05/2015 03/05/2016

42 1500000000824 PUSKESMAS TANJUNGPINANG/PANCUR

JL. IR. JUANDA NO.1 KEL. KP. BARU, KEC. TANJUNG PINANG BARAT

PUSKESMAS TANJUNGPINANG/PANCUR


43 1500000000824PUSKESMAS TANJUNGPINANG/PANCUR

JL. IR. JUANDA NO.1 KEL. KP. BARU, KEC. TANJUNG PINANG BARAT

PUSKESMAS TANJUNGPINANG/PANCUR


44 1500000000502 PUSKESMAS TELUK SASAH JALAN TELUK SASAH LOBAM BINTAN 085365206193

PUSKESMAS TELUK SASAH


07/04/2016 31/12/2018

45 1500000000502 PUSKESMAS TELUK SASAH JALAN TELUK SASAH LOBAM BINTAN 085365206193

PUSKESMAS TELUK SASAH


07/04/2015 06/04/2016

46 1500000000437 PUSKESMAS TELUK SEBONG JL RAYA DUKU SUNGAI KECIL08127769269

PUSKESMAS TELUK SEBONG PER/12/032015

RS.TRAUMA CENTRE 10/03/2015 09/03/2016

47 1500000000437 PUSKESMAS TELUK SEBONG JL RAYA DUKU SUNGAI KECIL08127769269

PUSKESMAS TELUK SEBONG PER/63/122015

RS.TRAUMA CENTRE 10/08/2016 31/12/2017

48 00311 RSAL DR MIDIYANTO JL CIPTADI 1 21428 PER/14/032016RS.TRAUMA CENTRE

04/03/2016 31/12/2016

49 1400000000093 RSUD KABUPATEN BINTAN JL. BAREK MOTOR NO 2B KIJANG RSUD KABUPATEN BINTAN


29/04/2015 28/04/2016


Periode : 01/01/2015 s/d 31/10/2016


82 / 44607-11-201606:23:31



IKS


50 1400000000093 RSUD KABUPATEN BINTAN JL. BAREK MOTOR NO 2B KIJANG RSUD KABUPATEN BINTAN PER/71/122015 RS.TRAUMA

CENTRE 29/04/2016 31/12/2016

51 1400000000061 RSUD KERPI TANJUNG UBAN 482795 PEMERINTAH PROPINSI

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

52 1400000000061 RSUD KERPI TANJUNG UBAN

482795 PEMERINTAH PROPINSI KEPRI


03/03/2015 02/03/2016

53 1500000000462 RSUD KOTA TANJUNGPINANG

JL SUDIRMAN 795 313000 RSUD KOTA TANJUNGPINANG


30/03/2016 31/12/2016

54 1500000000462 RSUD KOTA TANJUNGPINANG JL SUDIRMAN 795 313000 RSUD KOTA

TANJUNGPINANG PER/18/032015 RS.TRAUMA CENTRE 30/03/2015 29/03/2016

55 1500000001609 RSUD NATUNA JL. H.ALI MURTOPO, KABUPATEN NATUNA 31128 RSUD NATUNA PER/12/012016RS.TRAUMA CENTRE 08/09/2016 31/12/2018

56 1500000001609 RSUD NATUNA JL. H.ALI MURTOPO, KABUPATEN NATUNA 31128 RSUD NATUNA PER/47/062015 RS.TRAUMA CENTRE

22/06/2015 21/06/2016

57 1400000000013 RSUP KEPRI TANJUNGPINANG KM 8

JL. BARU SUNGAI CARANG KM.8 TANJUNGPINANG

PEMERINTAH PROVINSI KEPULAUAN RIAU


07/03/2016 31/12/2016

58 1400000000013RSUP KEPRI TANJUNGPINANG KM 8

JL. BARU SUNGAI CARANG KM.8 TANJUNGPINANG

PEMERINTAH PROVINSI KEPULAUAN RIAU PER/05/022015

RS.TRAUMA CENTRE 07/02/2015 06/02/2016

59 7-2375079192RUMAH SAKIT ANGKATAN LAUT DR MIDIYATO S TANJUNG PINANG

JALAN CIPTADI NO I TANJUNGPINANG 29111DR. AHMAD SAMSULHADI PER/14/032016

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

60 7-4661986430RUMAH SAKIT UMUM LAPANGAN LINGGA

JL. MASJID SULTAN LINGGA NO 46 KP DARAT KAB LINGGA

29872081372771583

DR DODDY ARFANSYAH PER/19/042016RS.TRAUMA CENTRE

09/09/2016 31/12/2016

61 1500000001890UPTD BALAI LATIHAN KERJA DISNAKERTRANS PROV. KEPRI

JL. DI PANJAITAN KM 8 NO 12 7007758UPTD BALAI LATIHAN KERJA DISNAKERTRANS PROV. KEPRI


25/03/2015 24/03/2016


Periode : 01/01/2015 s/d 31/10/2016


83 / 44607-11-201606:23:31


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


01/01/2015 31/12/2015

2 1400000000048 BATAMINDO INDUSTRIAL PARK KLINIK

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

29433 611907BATAMINDO INDUSTRIAL PARK KLINIK


3 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

4 1400000000382 BP BATAM VIEW BEACH RESORT

KOMPLEK BATAM VIEW BEACH RESORT JL.HANG LEKIR NONGSA 29466 761740 DR MELATI PER/11/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

5 1400000000026 BP BUDI ROSARI JALAN MAHKOTA SIMPANG NO.1 BENGKONG MAHKOTA BATAM

29458 BC GULIMAN MANURUNG


01/01/2016 31/12/2016

6 1400000000026 BP BUDI ROSARI JALAN MAHKOTA SIMPANG NO.1 BENGKONG MAHKOTA BATAM 29458 BC GULIMAN

MANURUNG PER/05/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

7 1400000000595 BP HARAPAN KITA BATU AJIRUKO CENTRAL MUKA KUNING BLOK A NO.8 BATU AJI 29438

0778361475

PT AUDY JAYA PRATAMA PER/47/122015

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

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

294380778361475

PT AUDY JAYA PRATAMA


22/06/2016 31/12/2016

9 7-764947233 BP HARAPAN KITA NAGOYA RUKO DIAN CENTER BLOK F NO 7 NAGOYA BATAM

29432 PT AUDY JAYA PRATAMA


01/12/2015 31/12/2016

10 1400000000025 BP HARAPAN KITA PURI LEGENDA

RUKO PURI LEGENDA BLOK D3 NO.17 BATAM

29464 8096104 YULIANA AMD.KEB SE PER/04/012015 RS.TRAUMA CENTRE

01/02/2015 31/12/2015

11 1400000000025BP 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

12 1500000000587BP HARAPAN KITA SUKAJADI

KOMP.RUKO TAMAN NIAGA BLOK N NO.03 SUKAJADI BATAM KOTA 29464 7372056 YULIANA AMD.KEB, SE PER/18/042015

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


Periode : 01/01/2015 s/d 31/10/2016


84 / 44607-11-201606:23:31



IKS


13 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

14 7-769170004 BP HARAPAN KITA VILLA PESONA ASRI

PERUM VILLA PESONA ASRI BLOK A19 NO.10 29433 077880995

68PT AUDY JAYA PRATAMA PER/46/122015 RS.TRAUMA

CENTRE 01/12/2015 31/12/2016

15 7-791402413 DELICIA MEDICAL CLINIC BIDA KABIL BLOK KEMBANG SARI NO 02 KEL KABIL KEC NONGSA

29431 07787497276

DR. HERLINA DELICIA BONG


18/12/2015 31/12/2016

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

29467 711569 EMMI KRISTIANI SIREGAR


01/01/2016 31/12/2016

17 1500000000348 KLINIK ALAM SEHAT KABILKOMP RUKO TAMAN JASINTA INDAH BLOKA NO 15-16 KEL KABIL KEC NONGSA BATAM

29467 711569 EMMI KRISTIANI SIREGAR PER/17/032015 RS.TRAUMA

CENTRE 01/03/2015 31/12/2015

18 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

19 7-3951407353 KLINIK HARAPAN KITA MARCHELIA

RUKO GRAND CALIFORNIA BLOK B2 NO.7 BATAM CENTER

29432 07784804259

PT HARAPAN JAYA MEDIKA


28/06/2016 31/12/2016

20 1500000000822 KLINIK HUSADATAMA JL.IMAM BONJOL KOMP.GALAXY NO.3-4 NAGOYA BATAM

29444 431457 DR.KRISMADIES, M.KKK PER/22/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

21 1500000000822 KLINIK HUSADATAMAJL.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

22 1400000000072 KLINIK MEDIKAJL R.E MARTADINATA, KOMP WIJAYA BLOK G NO.5 SEKUPANG. BATAM 29425

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

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

23 1400000000072 KLINIK MEDIKAJL R.E MARTADINATA, KOMP WIJAYA BLOK G NO.5 SEKUPANG. BATAM

29425082389094888

DR KRISMADIES, M.KKK PER/08/012015RS.TRAUMA CENTRE

01/01/2015 31/12/2015

24 1400000000466 KLINIK NAYAKA HUSADA 03KABIL

RUSUNAWA BPJS KETENAGAKERJAAN KABIL

29467 711448 PT NAYAKA ERA HUSADA


01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


85 / 44607-11-201606:23:31



IKS


25 1400000000466 KLINIK NAYAKA HUSADA 03KABIL

RUSUNAWA BPJS KETENAGAKERJAAN KABIL 29467 711448 PT NAYAKA ERA

HUSADA PER/12/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

26 1400000000074 KLINIK NAYAKA HUSADA 04NAGOYA

JL RAJA ALI HAJI JODOH KOMP TANJUNG PANTUN BLOK U NO.6 NAGOYA BATAM 29454 457857 DODDY SUDRAJAT PER/09/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

27 1400000000074 KLINIK 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

28 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

29 1400000000071 KLINIK PANBIL MEDIKA KOMP. PERDAGANGAN PANBIL BLOK A NO.9 MUKA KUNING BATAM 29433 371338 DR KRISMADIES, M.KKK PER/07/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

30 1500000000821 KLINIK PRIMA HUSADAKOMPLEK RUKO SMK ALJABAR BLOK B NO.3 BENGKONG INDAH BATAM 29458 61433634 DR.KRISMADIES,M.KKK PER/21/052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

31 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

32 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

33 1500000000819 KLINIK PURI SEHATRUKO PURI LEGENDA BLOK D3 NO.9 BATAM CENTER 29464 38701249 DR KRISMADIES, M.KKK PER/19/052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

34 7-3973918865KLINIK SANTA ELISABETH SEI LEKOP

KAV. SEI LEKOP RT.005/RW.007 KEL. SEI LEKOP KEC. SAGULUNG-KOTA BATAM 29439

0778-7207822 DR. WENNAS, SPA PER/04/062016

RS.TRAUMA CENTRE 29/06/2016 30/06/2017

35 1400000000297 KLINIK TAMARAJL ENGKU PUTRI RUKO TAMAN LAKOTA BLOK F NO 8-9 BATAM CENTER

29464 8097629DR ANJARI WAHYU WARDHANI


01/01/2015 31/12/2015

36 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


Periode : 01/01/2015 s/d 31/10/2016


86 / 44607-11-201606:23:31



IKS


37 1500000000820 KLINIK XYSTERA KOMPLEK GENTA PLAZA BLOK B NO. 5-6 MUKA KUNING BATAM 29439 7293995 DR KRISMADIES, M.KKK PER/20/052015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

38 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

39 0900000000028 RS AWAL BROS JL GAJAH MADA KAV I BALOI 29431 431777 DR WIDYA PUTRI PER/01/012016 RS.TRAUMA CENTRE

11/01/2016 31/03/2016

40 0900000000028 RS AWAL BROS JL GAJAH MADA KAV I BALOI 29431 431777 DR WIDYA PUTRI PER/01/062016 RS.TRAUMA CENTRE

06/06/2016 31/05/2017

41 0900000000028 RS AWAL BROS JL GAJAH MADA KAV I BALOI 29431 431777 DR WIDYA PUTRI PER/01/012015 RS.TRAUMA CENTRE 01/03/2015 31/12/2015

42 7-768491263RS BUDI KEMULIAAN BATAM JL BUDI KEMULIAAN NO.1 SERAYA BATAM 29432

0778454044 SRI SOEDARSONO PER/44/122015

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

43 0700000000015 RS CAMATHA SAHIDYA JL A YANI NO. 8 MUKA KUNING 29433 371003 PT CAMATHA SAHIDYA PER/02/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

44 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

45 1300000000017 RS HARAPAN BUNDA JL SERAYA 01. BATAM 29452 457333YAYASAN HARAPAN BUNDA PER/66/122015

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

46 1300000000017 RS HARAPAN BUNDA JL SERAYA 01. BATAM 29452 457333YAYASAN HARAPAN BUNDA PER/03/012015

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

47 7-3972977263RS SANTA ELISABETH BATAM

JLN ANGGREK BLOK II BALOI , LUBUK BAJA BATAM

29432457357/422096

DR. SAHAT HAMONANGAN SIAHAAN, MARS

PER / 02 / 062016

RS.TRAUMA CENTRE

29/06/2016 31/12/2016

48 7-3973544534 RS SANTA ELISABETH BATAM KOTA

JL. RAJA ALI KELANA, KEL. BELIAN, KEC. BATAM KOTA

29431 (0778)4803191

DR. HELMINA PURBA PER/03/062016 RS.TRAUMA CENTRE

29/06/2016 30/06/2017


Periode : 01/01/2015 s/d 31/10/2016


87 / 44607-11-201606:23:31



IKS


49 7-4856732543 RS SOEDARSONO DARMOSOEWITO HANG KESTURI KM 4,5 KABIL. BATAM 29467 0778-

711960 DR. M. ZAINI, MARS PER/25/092016 RS.TRAUMA CENTRE 19/09/2016 31/12/2017

KANTOR CABANG : D03- KANTOR CABANG DUMAI


IKS


1 1400000000208 BALAI PENGOBATAN MUTIARA KASIH

JL RAYA LUBUK GAUNG RT 008 SEI SEMBILAN IR BURJU SIHOMBING PER/ 34 / 062016 RS.TRAUMA

CENTRE 13/06/2016 31/05/2017

2 1400000000208BALAI PENGOBATAN MUTIARA KASIH

JL RAYA LUBUK GAUNG RT 008 SEI SEMBILAN IR BURJU SIHOMBING

PER / 21 / 062015

RS.TRAUMA CENTRE 18/04/2016 31/05/2016

3 1500000000239 BP AMANAH JL SOEKARNO HATTA KM 14 BAGAN BESAR 28882 DR. DEVY DIANNY PER/04/032015 RS.TRAUMA CENTRE

01/03/2015 31/12/2015

4 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

5 1400000000024KLINIK RAWAT INAP TUNAS MUDA MEDIKA JL WAN DAHLAN IBRAHIM NO 8 DUMAI 28811 439026 DR RAHMI SALBI PER/16/042015

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

6 1400000000024KLINIK 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

7 1400000000024KLINIK RAWAT INAP TUNAS MUDA MEDIKA

JL WAN DAHLAN IBRAHIM NO 8 DUMAI 28811 439026 DR RAHMI SALBI PER/16/042015RS.TRAUMA CENTRE

01/04/2015 31/12/2015

8 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


Periode : 01/01/2015 s/d 31/10/2016


88 / 44607-11-201606:23:31



IKS


9 1500000000623 KLINIK AL UMMI JL BELIMBING NO.123 KEL RIMBA SEKAMPUNG KEC. DUMAI KOTA 28811 34351 ANDI RONI PER/17/042015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

10 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

11 1500000000622 KLINIK AL UMMI SUNGAI SEMBILAN

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

28813 34351 ANDI RONI PER/18/042015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

12 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

13 1500000000238 KLINIK SEHATI JL. PANGERAN DIPONEGORO/SUKAJADI NOMOR 83B 28811 34584 DR. H. SUNARYO PER/03/032015 RS.TRAUMA

CENTRE 01/03/2015 31/12/2015

14 1500000000238 KLINIK SEHATIJL. PANGERAN DIPONEGORO/SUKAJADI NOMOR 83B 28811 34584 DR. H. SUNARYO PER/46/122015

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

15 1500000001416 PKM BAGAN BATU JL JEND SUDIRMAN NO 562 BAGAN BATU DINKES KAB ROHIL PER/28/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

16 1500000001407 PKM BAGAN PUNAK DESA BAGAN PUNAK DINKES KAB ROHIL PER/15/052016 RS.TRAUMA CENTRE

01/07/2016 31/12/2017

17 1500000001407 PKM BAGAN PUNAK DESA BAGAN PUNAK DINKES KAB ROHIL PER/38/062015RS.TRAUMA CENTRE 01/07/2015 30/06/2016

18 1500000001391 PKM BAGAN SIAPI-API JL. JAMBU NO.22 BAGAN SIAPIAPI DINKES KAB ROHIL PER/16/052016RS.TRAUMA CENTRE 01/07/2016 31/12/2017

19 1500000001391 PKM BAGAN SIAPI-API JL. JAMBU NO.22 BAGAN SIAPIAPI DINKES KAB ROHIL PER/23/062015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

20 1500000001408 PKM BALAI JAYA JL LINTAS BAGAN BATU SUMUT DINKES KAB ROHIL PER/37/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


89 / 44607-11-201606:23:31



IKS


21 1500000001408 PKM BALAI JAYA JL LINTAS BAGAN BATU SUMUT DINKES KAB ROHIL PER/17/052016 RS.TRAUMA CENTRE 01/07/2016 31/12/2017

22 1500000001405 PKM BANGKO JAYA JL. LINTAS RIAU-SUMUT KM 12 DINKES KAB ROHIL PER/18/052016 RS.TRAUMA CENTRE 21/07/2016 31/12/2017

23 1500000001405 PKM BANGKO JAYA JL. LINTAS RIAU-SUMUT KM 12 DINKES KAB ROHIL PER/24/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

24 1500000001412 PKM BANGKO KANAN JL ANAS MAAMUN BANGKO KANAN DINKES KAB ROHIL PER/32/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

25 1500000001412 PKM BANGKO KANAN JL ANAS MAAMUN BANGKO KANAN DINKES KAB ROHIL PER/19/052016 RS.TRAUMA CENTRE 21/07/2016 31/12/2017

26 1500000001417 PKM BATU HAMPAR KEC BATU HAMPAR DINKES KAB ROHIL PER/27/062015RS.TRAUMA CENTRE 01/07/2015 30/06/2016

27 1500000001417 PKM BATU HAMPAR KEC BATU HAMPAR DINKES KAB ROHIL PER/20/052016 RS.TRAUMA CENTRE

21/07/2016 31/12/2017

28 1500000000424 PKM BUKIT KAPUR JL. SOEKARNO HATTA KM 17 KEL BAGAN BESAR

78050705 DINAS KESEHATAN KOTA DUMAI


01/04/2015 31/03/2016

29 1500000000424 PKM BUKIT KAPURJL. SOEKARNO HATTA KM 17 KEL BAGAN BESAR 78050705

DINAS KESEHATAN KOTA DUMAI PER/10/03/2016

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

30 1500000000426 PKM BUKIT KAYU KAPURJL. SOEKARNO HATTA KM 27,5 KEL BUKIT KAYU KAPUR 78799339

DINAS KESEHATAN KOTA DUMAI PER/15/032015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

31 1500000000426 PKM BUKIT KAYU KAPURJL. SOEKARNO HATTA KM 27,5 KEL BUKIT KAYU KAPUR

78799339DINAS KESEHATAN KOTA DUMAI


04/04/2016 31/03/2017

32 1500000000432 PKM BUKIT TIMAH KOMP. BTN BUMI DUMAI BARU KEL BUKIT TIMAH



04/04/2016 31/03/2017


Periode : 01/01/2015 s/d 31/10/2016


90 / 44607-11-201606:23:31



IKS


33 1500000000432 PKM BUKIT TIMAH KOMP. BTN BUMI DUMAI BARU KEL BUKIT TIMAH 71304595 DINAS KESEHATAN

KOTA DUMAI PER/11/03/2015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

34 1500000000423 PKM BUMI AYU JL. BUDI UTOMO KEL BUMI AYU 18177095 DINAS KESEHATAN KOTA DUMAI PER/10/032015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

35 1500000000423 PKM BUMI AYU JL. BUDI UTOMO KEL BUMI AYU 18177095 DINAS KESEHATAN KOTA DUMAI


04/04/2016 31/03/2017

36 1500000000422 PKM DUMAI BARAT JL. MH THAMRIN KEL PANGKALAN SESAI 07593322 DINAS KESEHATAN KOTA DUMAI


01/04/2015 31/03/2016

37 1500000000422 PKM DUMAI BARAT JL. MH THAMRIN KEL PANGKALAN SESAI 07593322 DINAS KESEHATAN KOTA DUMAI PER/05/032016 RS.TRAUMA

CENTRE 04/04/2016 31/03/2017

38 1500000000419 PKM DUMAI KOTAJL. PATTIMURA KEL.DUMAI KOTA KEC. DUMAI KOTA 76879661


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

39 1500000000419 PKM DUMAI KOTA JL. PATTIMURA KEL.DUMAI KOTA KEC. DUMAI KOTA



01/04/2015 31/03/2016

40 1500000000421 PKM JAYAMUKTI JL. KH NASUTION KEL. JAYA MUKTI 83771888 DINAS KESEHATAN KOTA DUMAI


01/04/2015 31/03/2016

41 1500000000421 PKM JAYAMUKTI JL. KH NASUTION KEL. JAYA MUKTI 83771888DINAS KESEHATAN KOTA DUMAI PER/04/032016

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

42 1500000000425 PKM MEDANG KAMPAIJL. RAYA DUMAI SEI PAKNING KM 11 KEL. TELUK MAKMUR 28065693


RS.TRAUMA CENTRE 01/04/2015 31/03/2016

43 1500000000425 PKM MEDANG KAMPAIJL. RAYA DUMAI SEI PAKNING KM 11 KEL. TELUK MAKMUR

28065693DINAS KESEHATAN KOTA DUMAI

PER/11/03/2016RS.TRAUMA CENTRE

04/04/2016 31/03/2017

44 1500000001410 PKM PASIR LIMAU KAPAS KEC PASIR LIMAU KAPAS PER/21/052016 RS.TRAUMA CENTRE

21/07/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


91 / 44607-11-201606:23:31



IKS


45 1500000001410 PKM PASIR LIMAU KAPAS KEC PASIR LIMAU KAPAS PER/34/062015 RS.TRAUMA CENTRE 01/07/2015 30/06/2016

46 1500000001406 PKM PEDAMARAN JL. LINTAS PEDAMARAN PEKAITAN DINKES KAB ROHIL PER/22/052016 RS.TRAUMA CENTRE 21/07/2016 31/12/2017

47 1500000001406 PKM PEDAMARAN JL. LINTAS PEDAMARAN PEKAITAN DINKES KAB ROHIL PER/39/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

48 1500000001413 PKM PUJUD JL LINTAS DESA PUJUD DINKES KAB ROHIL PER/31/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

49 1500000001413 PKM PUJUD JL LINTAS DESA PUJUD DINKES KAB ROHIL PER/23/052016 RS.TRAUMA CENTRE 21/07/2016 31/12/2017

50 1500000000420 PKM PURNAMA JL. TUN SRI LANANG NO.3A KEL. PURNAMA 66780687DINAS KESEHATAN KOTA DUMAI PER/09/032015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

51 1500000000420 PKM PURNAMA JL. TUN SRI LANANG NO.3A KEL. PURNAMA 66780687 DINAS KESEHATAN KOTA DUMAI


04/04/2016 31/03/2017

52 1500000001641 PKM RANTAU KOPAR JL. LINTAS SEKAPAS RANTAU KOPAR DINKES KAB ROHIL PER/24/052016 RS.TRAUMA CENTRE

21/07/2016 31/12/2017

53 1500000001641 PKM RANTAU KOPAR JL. LINTAS SEKAPAS RANTAU KOPAR DINKES KAB ROHILPKM RANTAU KOPAR

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

54 1500000001418 PKM RANTAU PANJANG KIRI JL. JEND. SUDIRMAN SIMPANG PELITA PER/25/052016RS.TRAUMA CENTRE 21/07/2016 31/12/2017

55 1500000001418 PKM RANTAU PANJANG KIRI JL. JEND. SUDIRMAN SIMPANG PELITA PER/26/062015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

56 1500000001419 PKM RIMBA MELINTANG JL. LINTAS BAGAN SIAPIAPI DINKES KAB ROHIL PER/25/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


92 / 44607-11-201606:23:31



IKS


57 1500000001419 PKM RIMBA MELINTANG JL. LINTAS BAGAN SIAPIAPI DINKES KAB ROHIL PER/26/052016 RS.TRAUMA CENTRE 21/07/2016 31/12/2017

58 1500000001414 PKM SEDINGINAN JL KH ALIMUDDIN NO 03 DINKES KAB ROHIL PER/30/062015 RS.TRAUMA CENTRE 01/07/2015 30/06/2016

59 1500000001414 PKM SEDINGINAN JL KH ALIMUDDIN NO 03 DINKES KAB ROHIL PER/27/052016 RS.TRAUMA CENTRE

21/07/2016 31/12/2017

60 1500000001415 PKM SIMPANG KANAN JL DESA BAGAN NIBUNG DINKES KAB ROHIL PER/29/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

61 1500000001415 PKM SIMPANG KANAN JL DESA BAGAN NIBUNG DINKES KAB ROHIL PER/28/052016 RS.TRAUMA CENTRE 21/07/2016 31/12/2017

62 1500000001411 PKM SINABOI JL. LINTAS SINABOI KEPENGHULUAN PER/29/052016RS.TRAUMA CENTRE 21/07/2016 31/12/2017

63 1500000001411 PKM SINABOI JL. LINTAS SINABOI KEPENGHULUAN PER/33/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

64 1500000000433 PKM SUNGAI SEMBILAN JL. RAYA DUMAI BASILAM BARU KM 14 KEL. LUBUK GAUNG



04/04/2016 31/03/2017

65 1500000000433 PKM SUNGAI SEMBILANJL. RAYA DUMAI BASILAM BARU KM 14 KEL. LUBUK GAUNG 78038833

DINAS KESEHATAN KOTA DUMAI PER/12/03/2015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

66 1500000001409PKM TANAH PUTIH TJ MELAWAN

JL. LINTAS BAGAN SIAPIAPI-UJUNG TANJUNG DINKES KAB ROHIL PER/30/052016

RS.TRAUMA CENTRE 21/07/2016 31/12/2017

67 1500000001409PKM TANAH PUTIH TJ MELAWAN

JL. LINTAS BAGAN SIAPIAPI-UJUNG TANJUNG

DINKES KAB ROHIL PER/35/062015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

68 1400000000492 RS CAHAYA JL LINTAS RIAU UJUNG TANJUNG 28983 66818300 DRG CAHAYA PURNAMASARI


01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


93 / 44607-11-201606:23:31



IKS


69 1400000000207 RSUD DR RM PRATOMO JL PAHLAWAN NO 13 BAGAN SIAPIAPI 21731 RSUD DR RM PRATOMO PER/14/052016 RS.TRAUMA CENTRE 06/06/2016 31/05/2017

70 1400000000207 RSUD DR RM PRATOMO JL PAHLAWAN NO 13 BAGAN SIAPIAPI 21731 RSUD DR RM PRATOMO PER/22/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

71 1300000000020 RSUD DUMAI JL TANJUNG JATI NO 4 38367 PEMKO DUMAI PER/01/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

72 1300000000020 RSUD DUMAI JL TANJUNG JATI NO 4 38367 PEMKO DUMAI PER/50/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

KANTOR CABANG : D04- KANTOR CABANG RENGAT


IKS


1 7-693615009 KLINIK BUNDA DINDA JL LINTAS TIMUR UKUI 28382 DR RACHMAD SURYAWAN


01/12/2015 31/12/2016

2 7-692702507 KLINIK DINDA JL LINTAS TIMUR KM 118 28384DR RACHMAD SURYAWAN PER/17/112015

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

3 1500000000171KLINIK DUTA KUANSING MEDIKA JL. DIPONEGORO NO. 3 TALUK KUANTAN 7642345 PER/01/012015

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

4 1400000000130 KLINIK MEDISSRA JL. SULTAN NO. 101 RENGAT 71876761 ROHAIDAH PER/13/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

5 7-4966916603 KLINIK MEDISSRA JL SULTAN RENGAT 29312 DR LUSI LESTARI PER/08/062016 RS.TRAUMA CENTRE

28/09/2016 31/08/2017


Periode : 01/01/2015 s/d 31/10/2016


94 / 44607-11-201606:23:31



IKS


6 1400000000263 KLINIK MUIZZAH JL. RAYA PEMATANG REBA - PEKAN HERAN 29344 DR. LINA Y KIRAM PER/10/082016 RS.TRAUMA

CENTRE 09/08/2016 31/12/2017

7 1400000000263 KLINIK MUIZZAH JL. RAYA PEMATANG REBA - PEKAN HERAN 29344 DR. LINA Y KIRAM PER/11/062015 RS.TRAUMA

CENTRE 01/08/2015 31/07/2016

8 1400000000262 KLINIK MUIZZAH 2 JL. LINTAS TIMUR SIMP 4 BELILAS 29344 DR. LINA Y KIRAM PER/11/082016 RS.TRAUMA CENTRE

09/08/2016 31/12/2017

9 1400000000262 KLINIK MUIZZAH 2 JL. LINTAS TIMUR SIMP 4 BELILAS 29344 DR. LINA Y KIRAM PER/12/062015 RS.TRAUMA CENTRE

01/08/2015 31/07/2016

10 1500000000657 KLINIK PRATAMA DR RUDI ARDIAN JL. JEND. SUDIRMAN - PASIR PENYU 081268681

86 DR. RUDI ARDIAN PER/08/042015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

11 7-1200888333 KLINIK PRATAMA DR. IR JL TELAGA BIRU TEMBILAHAN HULU 29211 00021717CV INHIL SEHAT BERSAMA PER/18/122015

RS.TRAUMA CENTRE 29/12/2015 31/12/2016

12 7-2792259267 KLINIK PRATAMA THIP REGIONAL OFFICE PULAI 29255 PT THIP PLANTATIONS PER/01/042016 RS.TRAUMA CENTRE

05/04/2016 31/03/2017

13 1500000001907 PUSKESAMS LIRIK DESA LAMBANG SARI LIRIK 29312 DINAS KESEHATAN PER/09/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

14 1500000001906 PUSKESMAS AIR MOLEK JL JEND SUDIRMAN AIR MOLEK 29312 DINAS KESEHATAN PER/09/062015RS.TRAUMA CENTRE 01/07/2015 30/06/2016

15 1500000001897PUSKESMAS BATANG PERANAP DESA PERANAP KEC BATANG PERANAP 29312 DINAS KESEHATAN PER/09/062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

16 1500000001913PUSKESMAS KAMPUNG BESAR KOTA

JL HANGLEKIR KAMBESKO RENGAT 29312 DINAS KESEHATAN PER/09/062015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

17 1500000001901 PUSKESMAS KILAN DS BUKIT LUPAI BATANG CENAKU 29312 DINAS KESEHATAN PER/09/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


95 / 44607-11-201606:23:31



IKS


18 1500000001914 PUSKESMAS KUALA CENAKU DS KUALA CENAKU KEC KUALA CENAKU 29335 DINAS KESEHATAN PER/09/062015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

19 1500000001910 PUSKESMAS KULIM JAYA DS KULIM JAYA LUBUK BATU JAYA 29312 DINAS KESEHATAN PER/09/062015 RS.TRAUMA CENTRE 01/07/2015 30/06/2016

20 1500000001902 PUSKESMAS LUBUK KANDIS DESA KEPAYANG SARI BATANG CENAKU 29312 DINAS KESEHATAN PER/09/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

21 1500000001900 PUSKESMAS PANGKALAN KASAI

JL LINTAS TIMUR SEBERIDA 29312 DINAS KESEHATAN PER/09/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

22 1500000001911 PUSKESMAS PEKAN HERAN DESA PEKAN HERAN KEC RENGAT BARAT 29312 DINAS KESEHATAN PER/09/062015 RS.TRAUMA CENTRE 01/07/2015 30/06/2016

23 1500000001898 PUSKESMAS PERANAP JL PASAR PERANAP KECAMATAN PERANAP 7662247 DINAS KESEHATAN PER/09/062015RS.TRAUMA CENTRE 01/07/2015 30/06/2016

24 1500000001904 PUSKESMAS POLAK PISANG SIMPANG KOTA MEDAN KEC KELAYANG 29312 DINAS KESEHATAN PER/09/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

25 1500000001905 PUSKESMAS RAKIT KULIM DESA PETONGGAM RAKIT KULIM 29312 DINAS KESEHATAN PER/09/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

26 1500000001903 PUSKESMAS SEBERIDA SIMPANG EMPAT BELILAS 29312 DINAS KESEHATAN PER/09/062015RS.TRAUMA CENTRE 01/07/2015 30/06/2016

27 1500000001908 PUSKESMAS SEI LALA PERKEBUNAN SEI LALA KEC SEI LALA 29312 DINAS KESEHATAN PER/09/062015RS.TRAUMA CENTRE 01/07/2015 30/06/2016

28 1500000001899 PUSKESMAS SENCANO JAYA KEC BATANG PERANAP 29312 DINAS KESEHATAN PER/09/062015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

29 1500000001912 PUSKESMAS SIPAYUNG JL HANGTUAH SEKIP HULU KEC RENGAT 29312 DINAS KESEHATAN PER/09/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


96 / 44607-11-201606:23:31



IKS


30 1500000001909 PUSKESMAS SUNGAI PARIT DESA PASIR BONGKAL SEI LALA 29312 DINAS KESEHATAN PER/09/062015 RS.TRAUMA CENTRE 01/07/2015 30/06/2016

31 1500000000658 RS INDRAGIRI TEMBILAHAN JL. TRIMAS NO 77 TEMBILAHAN 23555 PT KENCANA INDRAGIRI MEDIKA PER/02/012015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

32 1400000000267 RSUD INDRASARI RENGAT JL. LINTAS TIMUR SUMATRA - RENGAT DR. IBRAHIM PER/10/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

33 7-4298622633 RSUD INDRASARI RENGAT JL. LINTAS SUMATRA -RENGAT - PEMATANG REBA

29344 PEMKAB INHU PER/08/062016 RS.TRAUMA CENTRE

08/08/2016 31/08/2017

34 1500000000664 RSUD PURI HUSADA TEMBILAHAN JL VETERAN NO 52 TEMBILAHAN 76822118 PEMKAB INHIL PER/06/032015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

35 1500000001978 RSUD TELUK KUANTANJL KESEHATAN NO. 1 SINAMBEK TALUK KUANTAN 29511 PEMDA KUANSING PER/14/102015

RS.TRAUMA CENTRE 15/10/2015 31/12/2016

KANTOR CABANG : D05- KANTOR CABANG DURI


IKS


1 1400000000092BALAI PENGOBATAN DIAN HUSADA JL. GAJAH MADA NO. 31 SEBANGA DURI 92404 HARIANSYAH PER/06/042015

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

2 1400000000092BALAI PENGOBATAN DIAN HUSADA

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

01/05/2015 30/04/2016

3 1400000000086 BALAI PENGOBATAN DURI MEDIKA

JL. JEND SUDIRMAN RT/RW 02/05 KEL. BALAI MAKAM DURI

594469 NENNI TRIANA PER/07/042015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


97 / 44607-11-201606:23:31



IKS


4 1400000000086 BALAI PENGOBATAN DURI MEDIKA

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

CENTRE 01/04/2016 31/12/2016

5 1500000000412 KLINIK NAYAKA HUSADA DURI

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


6 1500000000412 KLINIK NAYAKA HUSADA DURI

JL DEWI SARTIKA KELURAHAN BALIK ALAM KECAMATAN MANDAU

598085 PT NAYAKA ERA HUSADA


01/04/2016 31/12/2016

7 1500000000413 KLINIK NAYAKA HUSADA IIJALAN HANGTUAH RT 04 RW 01 DESA TAMBUSAI BATANG DUI KECAMATAN MANDAU



01/04/2016 31/12/2016

8 1500000000413 KLINIK NAYAKA HUSADA IIJALAN HANGTUAH RT 04 RW 01 DESA TAMBUSAI BATANG DUI KECAMATAN MANDAU

560757 PT NAYAKA ERA HUSADA PER/03/032015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

9 7-3273749957KLINIK PRATAMA ADELIA MEDICAL

JL LINTAS PEKANBARU DURI PANGKALAN LIBUT PINGGIR 28784 TAUFIK 7-3273749957

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

10 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

11 7-1704752493 KLINIK PRATAMA BERKAH JALAN LINTAS DURI – PEKANBARU DESA PINGGIR

28784 AFRIZAL TANJUNG 7-1704752493 RS.TRAUMA CENTRE

17/02/2016 31/12/2016

12 1500000000411 KLINIK PRATAMA HAYATIJL DURI-DUMAI KM 16 DESA BONCAH MAHANG KECAMATAN MANDAU 71049091 RUSYDI PER/01/032015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

13 1500000000411 KLINIK PRATAMA HAYATIJL DURI-DUMAI KM 16 DESA BONCAH MAHANG KECAMATAN MANDAU 71049091 RUSYDI PER/01/032015

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

14 1500000000593RSUD KECAMATAN MANDAU

JL. STADION NO. 10 DURI 7038918RSUD KECAMATAN MANDAU


01/04/2016 31/12/2016

15 1500000000593 RSUD KECAMATAN MANDAU

JL. STADION NO. 10 DURI 7038918 RSUD KECAMATAN MANDAU


01/04/2015 31/03/2016


Periode : 01/01/2015 s/d 31/10/2016


98 / 44607-11-201606:23:31



IKS


16 1400000000085 RUMAH SAKIT PERMATA HATI

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

SUKSES MEDIKA PER/05/042015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

17 1400000000085 RUMAH SAKIT PERMATA HATI

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

SUKSES MEDIKA PER/05/042015 RS.TRAUMA CENTRE 01/04/2016 31/12/2016

KANTOR CABANG : D06- KANTOR CABANG PEKANBARU PANAM


IKS


1 1500000001036 KLINIK ALKADRIAH JL HR SUBRANTAS NO 148 SIDOMULYO081276480467 ROMMY ADRIANTO PER/12/052015

RS.TRAUMA CENTRE 28/05/2015 27/05/2016

2 7-469185283 KLINIK CITRA BUNDA JL RAYA SUKARAMAI KEC. TAPUNG HULU KAB. KAMPAR

28464 HJ ROSINA. SKM PER/20/112015 RS.TRAUMA CENTRE

19/11/2015 11/11/2016

3 7-3620858263 KLINIK DR ELI SUSANTI RT.17/RW.04 DESA PETAPAHAN KEC. TAPUNG

28464 DR ELI SUSANTI PER/10/062016 RS.TRAUMA CENTRE

06/06/2016 31/05/2017

4 7-2621518864KLINIK FAMELA JAYA MEDIKA

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

RS.TRAUMA CENTRE 24/03/2016 20/03/2017

5 1500000000754 KLINIK KELUARGA KITAJL GARUDA SAKTI KM. 21 DESA BENCAH KELUBI KEC. TAPUNG

082311116191 MULYADI B PER/08/052015

RS.TRAUMA CENTRE 11/05/2015 10/05/2016

6 1500000000766KLINIK KELUARGA SEHAT DOKTOR BASTIAN

JL GARUDA SAKTI KM 2 7875077DR ADOLF BASTIAN TAMBUSAI.M.PD


11/05/2016 10/05/2017

7 1500000000766 KLINIK KELUARGA SEHAT DOKTOR BASTIAN

JL GARUDA SAKTI KM 2 7875077 DR ADOLF BASTIAN TAMBUSAI.M.PD


11/05/2015 10/05/2016


Periode : 01/01/2015 s/d 31/10/2016


99 / 44607-11-201606:23:31



IKS


8 1500000001032 KLINIK PANJI HUSADA DESA KABUN KAB. ROKAN HULU ZUSHENI GAYATRI PER/14/052015 RS.TRAUMA CENTRE 27/05/2015 26/05/2016

9 1500000001032 KLINIK PANJI HUSADA DESA KABUN KAB. ROKAN HULU ZUSHENI GAYATRI PER/24/062016 RS.TRAUMA CENTRE 11/08/2016 31/12/2017

10 1500000001027 KLINIK PRATAMA ANNISA MEDIKA 2

JL. HR. SOEBRANTAS NO 107 PANAM SIDOMULYO BARAT

081365798138

HJ. KARTINI. SKM PER/11/052015 RS.TRAUMA CENTRE

26/05/2015 25/05/2016

11 7-2671295923 KLINIK PRATAMA DAREL MEDIKA

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

24/03/2016 20/03/2017

12 7-329288012 KLINIK PRATAMA DOKTER AMELIA

JL PASIR PUTIH NO. 1 DESA TANAH MERAH KEC. SIAK HULU 28452 076170146

27DR AMELIA ANGGREINI MILALA PER/16/112015 RS.TRAUMA

CENTRE 12/11/2015 09/11/2016

13 7-2671295925KLINIK PRATAMA DOKTER HARRY BARMA JL RAYA PEKANBARU-BANGKINANG KM 39 28461 DR HARRY BARMA PER/05/032016

RS.TRAUMA CENTRE 24/03/2016 20/03/2017

14 7-616675225 KLINIK PRATAMA ELLIYA HUSADA

JL DELIMA NO 138 PANAM 28291 HJ ELLIYANNORA PER/22/112015 RS.TRAUMA CENTRE

27/11/2015 24/11/2016

15 7-325123713 KLINIK PRATAMA INDO SEHAT PEKANBARU

JL. KAHARUDIN NASUTION NO. 36-39 MARPOYAN DAMAI

28125 082288498728

DR MERY SISCANOVA PUTRI


11/11/2015 09/11/2016

16 1500000000538KLINIK PRATAMA UWA MEDIKA

JL HR SUBRANTAS NO 92 A-C KEL SIMPANGBARU 7872833 DR DEFRI PER/04/042015

RS.TRAUMA CENTRE 15/04/2015 14/04/2016

17 1500000000538KLINIK PRATAMA UWA MEDIKA

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

RS.TRAUMA CENTRE 15/04/2016 14/04/2017

18 7-2671295927POLIKLINIK KEBUN KOTO KAMPAR

PT PADASA ENAM UTAMA KEBUN KOTO KAMPAR

28453 SABAR PER/12/062016RS.TRAUMA CENTRE

06/06/2016 31/05/2017

19 1500000000986 RS AWAL BROS PANAM JL HR SOEBRANTAS TUAH KARYA 586888 IR ARFAN AWALOEDDINMARS


13/05/2015 12/05/2016


Periode : 01/01/2015 s/d 31/10/2016


100 / 44607-11-201606:23:31



IKS


20 1500000000986 RS AWAL BROS PANAM JL HR SOEBRANTAS TUAH KARYA 586888 IR ARFAN AWALOEDDINMARS PER/19/072015 RS.TRAUMA

CENTRE 05/08/2016 31/12/2017

21 1400000000152 RS AWAL BROS UJUNG BATU JL. JEND. SUDIRMAN NO. 314 UJUNGBATU 7363329 PT. AWAL BROS INTAN

MEDIKA PER/13/052015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

22 1400000000152 RS AWAL BROS UJUNG BATU

JL. JEND. SUDIRMAN NO. 314 UJUNGBATU 7363329 PT. AWAL BROS INTAN MEDIKA


25/10/2016 31/12/2017

23 7-4319915455 RS PRIMA PEKANBARU JL BIMA NO 1 NANGKA UJUNG TUANKU TAMBUSAI

28291 8419007 DR. ZULFIRMON, SP.OT. FICS

PER / 21 / 072016

RS.TRAUMA CENTRE

09/08/2016 31/12/2017

24 1500000000646 RS SURYA INSANI JL. DIPONEGORO KM 4 PASIR PENGARAIAN 7003404 PT.SURYA INSANI PER/05/042015 RS.TRAUMA CENTRE 22/04/2015 21/04/2016

25 1500000000646 RS SURYA INSANI JL. DIPONEGORO KM 4 PASIR PENGARAIAN 7003404 PT.SURYA INSANI PER/06/042016RS.TRAUMA CENTRE 22/04/2016 21/04/2017

26 1500000000770 RSIA BUNDA ANISYAH JL RAYA PEKANBARU BANGKINANG KM 52AIR TIRIS

081243533006

DR ANDRI SETIAWAN PER/09/052015 RS.TRAUMA CENTRE

12/05/2015 11/05/2016

27 1500000000770 RSIA BUNDA ANISYAH JL RAYA PEKANBARU BANGKINANG KM 52AIR TIRIS

081243533006

DR ANDRI SETIAWAN PER/11/062016 RS.TRAUMA CENTRE

06/06/2016 31/05/2017

28 7-3886640343 RSUD BANGKINANGJL LINGKAR BANGKINANG - BATU BELAH KABUPATEN KAMPAR 28461

0762323330 PEMERINTAH PER /13/062016

RS.TRAUMA CENTRE 22/06/2016 20/06/2018

29 7-3977546873RUMAH SAKIT JIWA TAMPAN JL HR SUBRANTAS KM 12.5 PEKANBARU 28291 076163240 PEMDA RIAU

PER / 16 / 062016

RS.TRAUMA CENTRE 30/06/2016 29/06/2018

30 7-3824363663 RUMAH SAKIT MESRA JL. RAYA PASIR PUTIH NO. 3 A-C 28452081365692268

MICHE SARI DEWI SE PER/26/082016RS.TRAUMA CENTRE

01/09/2016 31/12/2017

31 1400000000027 RUMAH SAKIT SANSANI JALAN SOEKARNO HATTA (ARENGKA ATAS) PEKANBARU

564666 SYAHRONI TUA PER/03/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016


Periode : 01/01/2015 s/d 31/10/2016


101 / 44607-11-201606:23:31



IKS


32 1400000000027 RUMAH SAKIT SANSANI JALAN SOEKARNO HATTA (ARENGKA ATAS) PEKANBARU 564666 SYAHRONI TUA PER/01/032016 RS.TRAUMA

CENTRE 01/04/2016 31/03/2017

KANTOR CABANG : D07- KANTOR CABANG BATAM SEKUPANG


IKS


1 1500000000475 BALAI LATIHAN KERJA DUAUTAMA JAYA

JL YOS SUDARSO, KOMP GREENTOWN WAREHOUSE NO 01 495120 M. TABRI PER/03/032015 RS.TRAUMA

CENTRE 27/03/2015 27/03/2016

2 1400000000011 KLINIK ASIA INDAH RUKO PUTRA JAYA BLOK A NO 10-11 7042991 MARTHEN TANDIRURA PER/01/012015RS.TRAUMA CENTRE 01/02/2015 31/01/2016

3 1500000001972 KLINIK ASIH TIBAN TIBAN I BLOK D7 NO. 3 KEL. PATAM LESTARI KEC. SEKUPANG

29412 322704 HJ GUSNAWATI PER/38/102015 RS.TRAUMA CENTRE

01/10/2015 30/09/2016

4 7-3712223302 KLINIK AULIA RUKO TUNAS REGENCY BLOK C6 NO 06, KEL SEI BINTI, KEC SAGULUNG BATAM

29422 07783850043

REFANDI GUCI PER/09/052016 RS.TRAUMA CENTRE

08/06/2016 31/12/2017

5 7-3565173742KLINIK BIOCARE INDONESIA

KOMP TUNAS REGENCY BLOK A1 NO 12, SAGULUNG, BATAM 29422

0778-2101112 DR ANDHIKA PER/06/052016

RS.TRAUMA CENTRE 06/06/2016 31/12/2017

6 1400000000574KLINIK 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

7 7-1265428985KLINIK GLOBAL MEDICAL CENTRE

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

2942807783582923

RIRIS LIANI PER/02/012016RS.TRAUMA CENTRE

05/01/2016 03/01/2017

8 1500000001252 KLINIK HUSADA KARIMUN JL. AHMAD YANI NO 7-8 KEC. MERAL KABUPATEN KARIMUN

325100 DR JUSRIZAL PER/36/052015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


102 / 44607-11-201606:23:31



IKS


9 1500000001252 KLINIK HUSADA KARIMUN JL. AHMAD YANI NO 7-8 KEC. MERAL KABUPATEN KARIMUN 325100 DR JUSRIZAL PER/17/062016 RS.TRAUMA

CENTRE 29/06/2016 31/12/2017

10 1500000001253 KLINIK MEDILAB KARIMUNJL.R.H FISABILILLAH RT/RW 003/004 DESA PANGKE KECAMATAN MERAL TANJUNG BALAI KARIMUN

082391076669 DR JUSRIZAL PER/18/062016 RS.TRAUMA

CENTRE 22/06/2016 31/12/2017

11 1500000001253 KLINIK MEDILAB KARIMUNJL.R.H FISABILILLAH RT/RW 003/004 DESA PANGKE KECAMATAN MERAL TANJUNG BALAI KARIMUN

082391076669

DR JUSRIZAL PER/35 /052015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

12 7-3711773309 KLINIK MUTIARA MEDICAL BATAM

JL GAJAH MADA CLUSTER MELATI RESIDENCE BLOK A NO 7 BATAM

29425 0778-326397

RUDI TONI MARBUN PER/08/052016 RS.TRAUMA CENTRE

09/06/2016 31/12/2017

13 7-3716170353 KLINIK MUTIARA MEDICAL BATAM

JL GAJAH MADA CLUSTER MELATI RESIDENCE BLOK A NO 7 BATAM 29425 077832639

7 RUDI TONI MARBUN PER/08/052016 RS.TRAUMA CENTRE 14/10/2016 31/12/2017

14 1500000001390 KLINIK TIBAN SEHATJL GAJAH MADA RAYA TIBAN LAMA NO 15 RT 01/13 TIBAN LAMA BATAM

081931178484 DR ADE MEGA JAYANTI PER/37/062015

RS.TRAUMA CENTRE 17/06/2015 16/06/2016

15 1400000000255 KLINIK VELY KOMPLEK RUKO FANINDO BLOK A NO 12 A KEL TANJUNG UNCANG

9131737 DR. SITI VERA NOTARINA


05/01/2016 03/02/2017

16 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

17 1500000000494 PKM TANJUNG BALAIJL. KARTINI NO.14 TANJUNG BALAI KARIMUN 21060 PER/31/032015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

18 1500000001982 RS GRAHA HERMINEJL JEND SOEPRAPTO RUKO ASIH RAYA BLOK B NO 6-15 BATUAJI 29412 363318

MHD INDRA GUNAWAN LUBIS PER/039/102015

RS.TRAUMA CENTRE 01/10/2015 30/09/2016

19 1500000001982 RS GRAHA HERMINEJL JEND SOEPRAPTO RUKO ASIH RAYA BLOK B NO 6-15 BATUAJI

29412 363318MHD INDRA GUNAWAN LUBIS


14/10/2016 31/12/2017

20 1000000000005 RS. CHARIS MEDIKA JL, R, SUPRAPTO BLOK D NO.1 BATU AJI BATAM

DR. JOHANA AQUARISTA PER/32/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016


Periode : 01/01/2015 s/d 31/10/2016


103 / 44607-11-201606:23:31



IKS


21 1000000000005 RS. CHARIS MEDIKA JL, R, SUPRAPTO BLOK D NO.1 BATU AJI BATAM DR. JOHANA AQUARISTA PER/29/102016 RS.TRAUMA

CENTRE 14/10/2016 31/12/2017

22 1305070000021RSUD EMBUNG FATIMAH KOTA BATAM (TRAUMA CENTER)

JL. R.SOEPRAPTO BLOK D NO.1-9 BATU AJI 364446 KOTA BATAM PER/34/042015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

23 1305070000021RSUD EMBUNG FATIMAH KOTA BATAM (TRAUMA CENTER)

JL. R.SOEPRAPTO BLOK D NO.1-9 BATU AJI 364446 KOTA BATAM PER/22/072016 RS.TRAUMA CENTRE

01/08/2016 31/12/2017

24 1400000000679 RSUD KABUPATEN KARIMUN

JL. SOEKARNO HATTA NO. 01 TANJUNG BALAI KARIMUN

327808 RSUD KABUPATEN KARIMUN


06/09/2016 31/12/2017

KANTOR CABANG : D15- KABUPATEN SIAK


IKS


1 7-4566178693 KLINIK KASIH IBU JLN LINTAS PKU DURI KM 80 PSR MINGGU KANDIS KOTA

28686 68441566 REHULINA BR. SEMBIRING

PER/21/062016 DAN NO 002/VI/2016

RS.TRAUMA CENTRE

30/08/2016 31/05/2018

KANTOR CABANG : E00- KANTOR CABANG JAMBI


IKS


1 1500000000660 BLK PROVINSI JAMBI JL YULIUS USMAN NO 09 PEMATANG SULUR TELANAIPURA


18/07/2016 31/03/2017

2 1500000000660 BLK PROVINSI JAMBI JL YULIUS USMAN NO 09 PEMATANG SULUR TELANAIPURA

PER / 08 / 042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016


Periode : 01/01/2015 s/d 31/10/2016


104 / 44607-11-201606:23:31



IKS


3 1500000000523 KLINIK ANANDA JAMBI JL LINTAS TEBING TINGGI RT 03 PER/ 14 / 082015 RS.TRAUMA CENTRE 02/08/2016 31/07/2018

4 1500000000523 KLINIK ANANDA JAMBI JL LINTAS TEBING TINGGI RT 03 PER / 02 / 032015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

5 7-5164081843 KLINIK RAWAT INAP TEMBESI MEDIKA

JL JAMBI MUARA BUNGO RT 08/11 KEL KAMPUNG BARU KEC MUARA TEMBESI

36653 DR HARMITA PER/ 20 / 092016 RS.TRAUMA CENTRE

20/10/2016 31/12/2017

6 1500000001212 KLINIK TANJUNG LUMUT JL LINGKAR TIMUR I TANJUNG LUMUT KELTALANG BAKUNG

PER / 14 / 062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2017

7 1500000001008 PUSKESMAS AUR DURI JL AUR DURI NO 1 PERUMNAS VILLA AUR DURI BLOK IB

PER / 13 / 052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2017

8 1500000000851 PUSKESMAS MERSAMJL LINTAS JAMBI - MA TEBO KM 102 MERSAM

PER / 11 / 052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2017

9 1500000000852 PUSKESMAS MUARA TEMBESI

JL JAMBI - MA BUNGO RT 8 KAMPUNG BARU MUARA TEMBESI

PER / 12 / 052015

RS.TRAUMA CENTRE

01/05/2015 30/04/2017

10 1500000000631 PUSKESMAS OLAK KEMANG JL K H HASAN ANANG NO 33 DANAU TELUK

PER / 09 / 042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2017

11 1500000000531 PUSKESMAS PAAL XJL MARSDA SURYA DARMA KOTA BARU JAMBI 98555604

PER / 03 / 042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2017

12 1500000000545 PUSKESMAS PAKUAN BARU JL JENDRAL SUDIRMAN JAMBI SELATAN 744901PER / 05 / 042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2017

13 1500000001211 PUSKESMAS PUTRI AYU JL SLAMET RIYADI NO 02 LGOKPER / 16 / 062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2017

14 1500000001243 PUSKESMAS SIMPANG KAWAT

JL HOS COKROAMINOTO KEC JELUTUNG PER / 17 / 062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2017


Periode : 01/01/2015 s/d 31/10/2016


105 / 44607-11-201606:23:31



IKS


15 1500000000546 PUSKESMAS TAHTUL YAMAN JL K H TOMOK KEC PELAYANGAN 74066247 PER / 06 /

042015RS.TRAUMA CENTRE 01/04/2015 31/03/2017

16 1500000000543 PUSKESMAS TANJUNG PINANG JL TARUMA NEGARA NO50 KOTA JAMBI 10001415 PER / 04 /

042015RS.TRAUMA CENTRE 01/04/2015 31/03/2017

17 1400000000559 RS BHAYANGKARA JAMBI JL RADEN MATTAHER NO 03 23246 PER / 03 / 012016

RS.TRAUMA CENTRE

20/01/2016 30/11/2016

18 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

19 1500000001224 RS RIMBO MEDIKA JL PATIMURA RT 02 KENALI BESAR PER / 15 / 062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2017

20 1400000000560 RS ROYAL PRIMA JAMBI JL RADEN WIJAYA RT 35 KEBON KOPIPER / 01 / 012016

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

21 1400000000095 RSUD AHMAD RIPIN JL LINTAS SUMATERA SENGETI PERJ/07/042015 RS.TRAUMA CENTRE

21/04/2015 30/03/2016

22 1400000000095 RSUD AHMAD RIPIN JL LINTAS SUMATERA SENGETI PER / 15 / 082016

RS.TRAUMA CENTRE

20/10/2016 31/12/2017

23 1400000000096 RSUD DAUD ARIFJL SYARIF HIDAYATULLAH KUALA TUNGKAL

PER / 19 / 082015

RS.TRAUMA CENTRE 21/04/2015 31/12/2015

24 1400000000096 RSUD DAUD ARIFJL SYARIF HIDAYATULLAH KUALA TUNGKAL PER/05/012016

RS.TRAUMA CENTRE 24/06/2016 31/12/2016

25 1400000000028 RSUD H ABDUL MANAPJL SK RD SYAHBUDDIN MAYANG MANGURAI

670455PER / 06 / 012016

RS.TRAUMA CENTRE

29/04/2016 31/12/2016

26 1000000000004 RSUD HAJI ABDOEL MADJID BATOE

JL PROF DR SRI SUDEWI, SH MUARA BULIAN

PER / 18 / 072015

RS.TRAUMA CENTRE

08/04/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


106 / 44607-11-201606:23:31



IKS


27 1400000000250 RSUD NURDIN HAMZAH JL WR SUPRATMAN MUARA SABAK 81258045 PER / 20 / 082015

RS.TRAUMA CENTRE 09/06/2015 31/12/2015

28 1400000000094 RSUD RADEN MATTAHER JAMBI LETJEN SUPRAPTO NO 31 TELANAIPURA 61692 PER/10/062016 RS.TRAUMA

CENTRE 13/07/2016 31/12/2018

29 1400000000094 RSUD RADEN MATTAHER JAMBI

LETJEN SUPRAPTO NO 31 TELANAIPURA 61692 PERJ/001/012015 RS.TRAUMA CENTRE

10/01/2015 31/12/2015

30 1500000000850 RSUD SULTAN THAHA SYAIFUDDIN

JL SULTAN THAHA SYAIFUDDIN KM 04 PER / 16/ 082016 RS.TRAUMA CENTRE

31/08/2016 31/07/2018

31 1500000000850 RSUD SULTAN THAHA SYAIFUDDIN JL SULTAN THAHA SYAIFUDDIN KM 04 PER / 10 /

052015RS.TRAUMA CENTRE 01/05/2015 30/04/2016

32 7-4467766903RUMAH SAKIT ST THERESIA JAMBI JL SUTOMO NO 19 JAMBI 36111 074123119 YAYASAN BAKTI UTAMA PER / 17 /082016

RS.TRAUMA CENTRE 31/08/2016 30/07/2018

KANTOR CABANG : E01- KANTOR CABANG MUARO BUNGO


IKS


1 1500000000520KLINIK BHAYANGKARA POLRES MERANGIN JL LINTAS SUMATERA KM 2 KEC BANGKO 21046 POLRES MERANGIN PER/02/042015

RS.TRAUMA CENTRE 09/04/2015 08/04/2017

2 7-4690135513 KLINIK EL PUTRI JL ASAHAN DUSUN PURWOSARI 37252 DR ISKANDAR PER/15/082016RS.TRAUMA CENTRE

13/09/2016 30/08/2018

3 1500000000634 KLINIK MGC 24 (KLINIK TC) JL LINTAS SUMATERA KM 04 RT 005 RW 10 DESA SUNGAI ULAK KEC NALO TANTAN

37311 DRG MERRY WAHYUNI PER/18/082016 RS.TRAUMA CENTRE

08/09/2016 23/04/2017


Periode : 01/01/2015 s/d 31/10/2016


107 / 44607-11-201606:23:31



IKS


4 1500000000634 KLINIK MGC 24 (KLINIK TC) JL LINTAS SUMATERA KM 04 RT 005 RW 10 DESA SUNGAI ULAK KEC NALO TANTAN 37311 DRG MERRY WAHYUNI PER/04/042015 RS.TRAUMA

CENTRE 24/04/2015 23/04/2016

5 7-2348650113 KLINIK RATU DUTA JL LINTAS SUMATERA KM 01 KEL PASAR SAROLANGUN 37481 INDRA GUNAWAN SE PER/01/032016 RS.TRAUMA

CENTRE 22/03/2016 28/02/2017

6 7-4591436996 KLINIK RIDHO BERSAMA JL BATANG HARI KUAMANG KUNING I DUSUN PURWOSARI

37252 DR ASHARI PARTUA OIL TAMBUNAN


31/08/2016 31/08/2018

7 7-4591050873 KLINIK SAKINAH JL ASAHAN RT 037 RW 001 DUSUN PURWOSARI KEC PELEPAT ILIR

37252 DR ERIZA ANWAR PER/13/082016 RS.TRAUMA CENTRE

31/08/2016 31/08/2018

8 1400000000052 KLINIK SEHAT KELUARGA CERIA

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

M EFFENDI HARAHAP PER/08/062015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

9 1400000000052KLINIK SEHAT KELUARGA CERIA

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

M EFFENDI HARAHAP PER/ 03/ 032016RS.TRAUMA CENTRE 31/05/2016 31/03/2017

10 1500000000958 KLINIK TC GANDI MEDIKA 5 JL PAHLAWAN KEL WIROTHO AGUNG KEC RIMBO BUJANG

MARLENA HARTATI PER/05/052016 RS.TRAUMA CENTRE

28/06/2016 31/05/2017

11 1500000000958 KLINIK TC GANDI MEDIKA 5 JL PAHLAWAN KEL WIROTHO AGUNG KEC RIMBO BUJANG

MARLENA HARTATI PER/05/052015 RS.TRAUMA CENTRE

25/05/2015 26/05/2016

12 1500000001154KLINIK TC RIMBO MEDICAL CENTER

JLN. PAHLAWAN UNIT 2 (SIMPANG JLN. 10) KEC. RIMBO BUJANG DR DIDIK AFRIADI MMR PER/06/052016

RS.TRAUMA CENTRE 28/06/2016 31/05/2017

13 1500000001154KLINIK TC RIMBO MEDICAL CENTER

JLN. PAHLAWAN UNIT 2 (SIMPANG JLN. 10) KEC. RIMBO BUJANG DR DIDIK AFRIADI MMR PER/07/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

14 1500000001149PUSKEMAS MUKO-MUKO BATHIN VII TC

JL KOMPLEK PERKANTORAN NO 02 TANJUNG AGUNG KEC MUKO-MUKO BATHIN VII

DINAS KESEHATAN KAB BUNGO


01/06/2015 31/05/2016

15 1500000001153 PUSKEMAS RANTAU KELOYANG

RANTAU KELOYANG KEC PELEPAT DINAS KESEHATAN KAB BUNGO


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


108 / 44607-11-201606:23:31



IKS


16 1500000001136 PUSKESMAS BABEKO TC DS BABEKO KEC BATHIN II BABEKO DINAS KESEHATAN KAB BUNGO PER/06/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

17 1500000001148 PUSKESMAS BATHIN III TC DS AIR GEMURUH KEC BATHI III DINAS KESEHATAN KAB BUNGO PER/06/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

18 1500000001150 PUSKESMAS BATHIN III ULUTC

DS. MUARA BUAT KEC. BATHIN III ULU DINAS KESEHATAN KAB BUNGO


01/06/2015 31/05/2016

19 1500000001140 PUSKESMAS KUAMANG JAYA TC

DS KUAMANG KEC PELEPAT ILIR DINAS KESEHATAN KAB BUNGO


01/06/2015 31/05/2016

20 1500000001139 PUSKESMAS KUAMANG KUNING I TC DS KUAMANG JAYA KEC PELEPAT ILIR DINAS KESEHATAN KAB

BUNGO PER/06/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

21 1500000001138PUSKESMAS KUAMANG KUNING X TC

JL BHAKTI HUSADA DUSUN MULIA BHAKTIKEC PELEPAT

DINAS KESEHATAN KAB BUNGO PER/06/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

22 1500000001152 PUSKESMAS LIMBUR LUBUK MENGKUANG TC

DS. LIMBUR LB. MENGKUANG KEC LIMBURLUBUK MENGKUANG



01/06/2015 31/05/2016

23 1500000001147 PUSKESMAS MUARA BUNGOI TC

JL KESUMA MUARA BUNGO KEC PASAR MUARA BUNGO

DINAS KESEHATAN KABUPATEN BUNGO


01/06/2015 31/05/2016

24 1500000001137PUSKESMAS MUARA BUNGOII

JL DURIAN DS SUNGAI ARANG KEC BUNGODANI

DINAS KESEHATAN KAB BUNGO PER/06/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

25 1500000001146 PUSKESMAS PELAYANG TC DS PELAYANG KEC BATHIN II PELAYANGDINAS KESEHATAN KAB BUNGO PER/06/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

26 1500000001151PUSKESMAS PULAU BATU TC

DS PULAU BATU KEC JUJUHAN ILIRDINAS KESEHATAN KAB BUNGO


01/06/2015 31/05/2016

27 1500000001143 PUSKESMAS RANTAU IKIL TC

DS RANTAU IKIL KEC JUJUHAN DINAS KESEHATAN KAB BUNGO


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


109 / 44607-11-201606:23:31



IKS


28 1500000001141 PUSKESMAS RANTAU PANDAN TC

DS RANTAU PANDAN KEC RANTAU PANDAN

DINAS KESEHATAN KAB BUNGO PER/06/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

29 1500000001144 PUSKESMAS TANAH SEPENGGAL LINTAS TC

JL LINTAS SUMATERA KM 25 ARAH PADANG KEC TANAH SEPENGGAL LINTAS

DINAS KESEHATAN KAB BUNGO PER/06/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

30 1500000001145 PUSKESMAS TANAH SEPENGGAL TC

JL TANAH TUMBUH PASA LUBUK LANDAI KEC TANAH SEPENGGAL



01/06/2015 31/05/2016

31 1500000001142 PUSKESMAS TANAH TUMBUH TC

JL BUKIT HARAPAN KEC TANAH TUMBUH DINAS KESEHATAN KAB BUNGO


01/06/2015 31/05/2016

32 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

33 1400000000053RSUD CHATIB QUZWAIN SAROLANGUN

JL. LINTAS SUMATERA KM.09 DESA BUKIT,SAROLANGUN DR IRWAN MISWAR PER/04/032015

RS.TRAUMA CENTRE 01/03/2015 29/02/2016

34 1400000000053 RSUD CHATIB QUZWAIN SAROLANGUN

JL. LINTAS SUMATERA KM.09 DESA BUKIT,SAROLANGUN

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

11/05/2016 28/02/2017

35 1400000000400 RSUD H HANAFIE MUARA BUNGO

JLN TEUKU UMAR NO 68 MUARO BUNGO 37211 21314 DR SAFFARUDIN MATONDANG MPH


01/09/2015 31/08/2016

36 1400000000400RSUD H HANAFIE MUARA BUNGO JLN TEUKU UMAR NO 68 MUARO BUNGO 37211 21314

DR SAFFARUDIN MATONDANG MPH PER/12/082016

RS.TRAUMA CENTRE 20/09/2016 31/08/2018

37 1500000000588RSUD KOL ABUNDJANI BANGKO - TC JL KESEHATAN NO 20 BANGKO PEMKAB MERANGIN PER/03/042015

RS.TRAUMA CENTRE 20/04/2015 19/04/2016

38 1500000000588RSUD KOL ABUNDJANI BANGKO - TC

JL KESEHATAN NO 20 BANGKO PEMKAB MERANGIN PER/09/062016RS.TRAUMA CENTRE

29/08/2016 09/06/2017

KANTOR CABANG : G00- KANTOR CABANG PALEMBANG


Periode : 01/01/2015 s/d 31/10/2016


110 / 44607-11-201606:23:31



IKS


1 1500000000930 BP INDRATAMA MEDICA CENTER

JALAN MP MANGKU NEGARA NO.10 RT.002/012 KELURAHAN KALIDONI PALEMBANG

Per/05/052016 RS.TRAUMA CENTRE 24/06/2016 30/04/2017

2 1500000000930 BP INDRATAMA MEDICA CENTER

JALAN MP MANGKU NEGARA NO.10 RT.002/012 KELURAHAN KALIDONI PALEMBANG


3 1400000000178 BP KESEHATAN KERJA JL A YANI NO 111 KEL 16 ULU DR WAHYUDI SAHADI PER/23/062015 RS.TRAUMA CENTRE

26/05/2015 30/04/2016

4 1500000000931 BP REZKY MEDICA

JALAN TANJUNG SIAPI-API / LETJEN HARUN SOHAR RT.042/010 KELURAH KEBUN BUNGA KECAMATAN SUKARAMI PALEMBANG

WIDIANTI PER/04/052016 RS.TRAUMA CENTRE

01/05/2016 30/04/2017

5 1500000000931 BP REZKY MEDICA

JALAN TANJUNG SIAPI-API / LETJEN HARUN SOHAR RT.042/010 KELURAH KEBUN BUNGA KECAMATAN SUKARAMI PALEMBANG

WIDIANTI PER/19/052015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

6 1500000001095 BP RIZKY ASYIFAJL. KAPTEN A RIVAI NO. 80D RT.030/009 KEL26 ILIR BUKIT KECIL DR. YESSY PER/25/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

7 1500000000929 KLINIK DIATARI MEDIKAJL. MP. MANGKUNEGARA KOMP. PUSRI KEBON SIRIH NO.1 KELURAHAN BUKIT SANGKAL KALIDONI PALEMBANG

FARIDA PER/18/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

8 1500000000929 KLINIK DIATARI MEDIKAJL. MP. MANGKUNEGARA KOMP. PUSRI KEBON SIRIH NO.1 KELURAHAN BUKIT SANGKAL KALIDONI PALEMBANG

FARIDA PER/19/062016 RS.TRAUMA CENTRE

01/08/2016 31/12/2018

9 1500000000707KLINIK NAYAKA HUSADA - 04

JL. ALAMSYAH SATU PN RT.53/16 KELURAHAN BUKIT LAMA KEC.ILIR BARAT 1

NAYAKA ERA HUSADA PER/08/052016RS.TRAUMA CENTRE 06/06/2016 31/03/2017

10 1500000000707 KLINIK NAYAKA HUSADA - 04

JL. ALAMSYAH SATU PN RT.53/16 KELURAHAN BUKIT LAMA KEC.ILIR BARAT 1

NAYAKA ERA HUSADA PER/06/042015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

11 1400000000164 KLINIK NAYAKA HUSADA 02 JL BASUKI RAHMAT NO 1676 DR ERDAYANA FATMA PER/10/042015RS.TRAUMA CENTRE

07/04/2015 06/04/2016

12 1400000000164 KLINIK NAYAKA HUSADA 02 JL BASUKI RAHMAT NO 1676 DR ERDAYANA FATMA PER/06/052016 RS.TRAUMA CENTRE

06/06/2016 30/04/2017


Periode : 01/01/2015 s/d 31/10/2016


111 / 44607-11-201606:23:31



IKS


13 1500000000706 KLINIK NAYAKA HUSADA-03 JL SUKABANGUN II A2 RT.006 RW.02 5612245 NAYAKA ERA HUSADA PER/07/052016 RS.TRAUMA

CENTRE 06/06/2016 31/03/2017

14 1500000000706 KLINIK NAYAKA HUSADA-03 JL SUKABANGUN II A2 RT.006 RW.02 5612245 NAYAKA ERA HUSADA PER/05/042015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

15 1400000000166 KLINIK OPINA JL KADIR TKR LR SAILUN NO 1200 DR H TRISNAWARMAN PER/14/042015 RS.TRAUMA CENTRE

24/04/2015 31/03/2016

16 1500000000493 KLINIK PKU MUHAMMADIYAH PLAJU

JL. KAPTEN ABDULLAH NO. 02 RT.030 KELURAHAN PLAJU ILIR KECAMATAN PLAJU PALEMBANG

542628DR. YUNIAR SARI (YAYASAN MUHAMMADIYAH)


01/04/2015 31/03/2016

17 1500000000493 KLINIK PKU MUHAMMADIYAH PLAJU

JL. KAPTEN ABDULLAH NO. 02 RT.030 KELURAHAN PLAJU ILIR KECAMATAN PLAJU PALEMBANG

542628DR. YUNIAR SARI (YAYASAN MUHAMMADIYAH)


18 1400000000177 KLINIK YAZRI JL MAY ZEN KOMP PT PUSRI PALEMBANG DR YUDA FETTY P PER/22/062015RS.TRAUMA CENTRE 26/05/2015 30/04/2016

19 1500000000962 PUSKESMAS 1 ULU JL. H. FAQIH USMAN NO. 2329 RT. 43 ULU LAUT, KEC. SEBERANG ULU I

DR.HURRIAH DEWI S. PANJAITAN


15/08/2016 31/05/2018

20 1500000000962 PUSKESMAS 1 ULU JL. H. FAQIH USMAN NO. 2329 RT. 43 ULU LAUT, KEC. SEBERANG ULU I

DR.HURRIAH DEWI S. PANJAITAN


01/06/2015 31/05/2016

21 1500000001010 PUSKESMAS 11 ILIRJL. SLAMET RIADY NO. 455 11 ILIR , KEC. ILIR TIMUR II DR. H. EZRIN NOER PER/26/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

22 1500000001010 PUSKESMAS 11 ILIRJL. SLAMET RIADY NO. 455 11 ILIR , KEC. ILIR TIMUR II DR. H. EZRIN NOER PER/26/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

23 1500000001010 PUSKESMAS 11 ILIRJL. SLAMET RIADY NO. 455 11 ILIR , KEC. ILIR TIMUR II

DR. H. EZRIN NOER PER/12/052016RS.TRAUMA CENTRE

15/08/2016 31/05/2018

24 1500000000977 PUSKESMAS 23 ILIR JL. DATUK M. AKIB NO. 100, KEC. BUKIT KECIL

DR. SALMAH HAMID PER/12/052016 RS.TRAUMA CENTRE

15/08/2016 31/05/2018


Periode : 01/01/2015 s/d 31/10/2016


112 / 44607-11-201606:23:31



IKS


25 1500000000977 PUSKESMAS 23 ILIR JL. DATUK M. AKIB NO. 100, KEC. BUKIT KECIL DR. SALMAH HAMID PER/26/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

26 1500000000965 PUSKESMAS 4 ULU JL. WAHID HASYIM 4 ULU DARAT, KEC. SEBERANG ULU I DR. H. NURHAYATI PER/26/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

27 1500000000965 PUSKESMAS 4 ULU JL. WAHID HASYIM 4 ULU DARAT, KEC. SEBERANG ULU I

DR. H. NURHAYATI PER/12/052016 RS.TRAUMA CENTRE

15/08/2016 31/05/2018

28 1500000000987 PUSKESMAS 5 ILIR JL. BAMBANG UTOYO, KEC. ILIR TIMUR II DR. PEMI WELRADO PER/12/052016 RS.TRAUMA CENTRE

15/08/2016 31/05/2018

29 1500000000987 PUSKESMAS 5 ILIR JL. BAMBANG UTOYO, KEC. ILIR TIMUR II DR. PEMI WELRADO PER/26/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

30 1500000000966 PUSKESMAS 7 ULUJL. K.H. AZHARI 7 ULU, KEC. SEBERANG ULU I DR. RUSTINA PER/12/052016

RS.TRAUMA CENTRE 15/08/2016 31/05/2018

31 1500000000966 PUSKESMAS 7 ULU JL. K.H. AZHARI 7 ULU, KEC. SEBERANG ULU I

DR. RUSTINA PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

32 1500000001013 PUSKESMAS ALANG-ALANGLEBAR

KEC. ALANG ALANG LEBAR DR. HJ. SYARI MASYITAH PER/12/052016 RS.TRAUMA CENTRE

15/08/2016 31/05/2018

33 1500000001013PUSKESMAS ALANG-ALANGLEBAR KEC. ALANG ALANG LEBAR DR. HJ. SYARI MASYITAH PER/26/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

34 1500000000979 PUSKESMAS ARIODILLAHJL. ARIODILLAH NO. 2102, KEC. ILIR TIMUR I

DR. HJ. MARTINA MUDJITABA PER/12/052016

RS.TRAUMA CENTRE 15/08/2016 31/05/2018

35 1500000000979 PUSKESMAS ARIODILLAHJL. ARIODILLAH NO. 2102, KEC. ILIR TIMUR I

DR. HJ. MARTINA MUDJITABA


01/06/2015 31/05/2016

36 1500000000983 PUSKESMAS BASUKI RAHMAT

JL. SERSAN SANI NO. 1350 RT. 18, KEC. KEMUNING

DR. RA. EMIRIA UMI K PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


113 / 44607-11-201606:23:31



IKS


37 1500000000983 PUSKESMAS BASUKI RAHMAT

JL. SERSAN SANI NO. 1350 RT. 18, KEC. KEMUNING DR. RA. EMIRIA UMI K PER/12/052016 RS.TRAUMA

CENTRE 15/08/2016 31/05/2018

38 1500000000989 PUSKESMAS BOOM BARU JL. MAYOR MEMET SASTRAWIRYA NO. 29 LAWANG KIDUL, KEC. ILIR TIMUR II DR. DIAN HAYATI PER/12/052016 RS.TRAUMA

CENTRE 15/08/2016 31/05/2018

39 1500000000989 PUSKESMAS BOOM BARU JL. MAYOR MEMET SASTRAWIRYA NO. 29 LAWANG KIDUL, KEC. ILIR TIMUR II

DR. DIAN HAYATI PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

40 1500000000998 PUSKESMAS BUKIT SANGKAL

JL. TANJUNG SARI II NO. 46 RT. 33, KEC. KALIDONI

DR. HILDA MARHAENI PER/12/052016 RS.TRAUMA CENTRE

15/08/2016 31/05/2018

41 1500000000998 PUSKESMAS BUKIT SANGKAL

JL. TANJUNG SARI II NO. 46 RT. 33, KEC. KALIDONI DR. HILDA MARHAENI PER/26/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

42 1500000000980 PUSKESMAS DEMPOJL. KOLONEL ATMO NO. 17, KEC. ILIR TIMUR I

DR. HJ. MEIRI IRYANI, M.KES PER/26/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

43 1500000000980 PUSKESMAS DEMPO JL. KOLONEL ATMO NO. 17, KEC. ILIR TIMUR I

DR. HJ. MEIRI IRYANI, M.KES


15/08/2016 31/05/2018

44 1500000000960 PUSKESMAS GANDUS JL. TPH. SOFYAN KENAWAS NO. 690, KEC. GANDUS

DR. APRIYANTI PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

45 1500000000960 PUSKESMAS GANDUSJL. TPH. SOFYAN KENAWAS NO. 690, KEC. GANDUS DR. APRIYANTI PER/12/052016

RS.TRAUMA CENTRE 15/08/2016 31/05/2018

46 1500000001001 PUSKESMAS KALIDONIJL. TALANG GADNG RT. 07 NO. 78 TALANG GADING, KEC. KALIDONI DR. DOVI YUNIARTI PER/26/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

47 1500000001001 PUSKESMAS KALIDONIJL. TALANG GADNG RT. 07 NO. 78 TALANG GADING, KEC. KALIDONI

DR. DOVI YUNIARTI PER/12/052016RS.TRAUMA CENTRE

15/08/2016 31/05/2018

48 1500000000973 PUSKESMAS KAMPUS JL. GOLF BLOK G-6 KAMPUS, KEC. ILIR BARAT I

DR. YULIARNI PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


114 / 44607-11-201606:23:31



IKS


49 1500000000973 PUSKESMAS KAMPUS JL. GOLF BLOK G-6 KAMPUS, KEC. ILIR BARAT I DR. YULIARNI PER/12/052016 RS.TRAUMA

CENTRE 15/08/2016 31/05/2018

50 1500000000969 PUSKESMAS KARYA JAYA DS. KARYA JAYA DARAT, KEC. KERTAPATI DR. DARLINA PER/12/052016 RS.TRAUMA CENTRE 15/08/2016 31/05/2018

51 1500000000969 PUSKESMAS KARYA JAYA DS. KARYA JAYA DARAT, KEC. KERTAPATI DR. DARLINA PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

52 1500000000990 PUSKESMAS KENTEN JL. MANGKUNEGARA NO. 1 KENTEN, KEC. ILIR TIMUR II

DR. HJ. AGUSTINI PER/12/052016 RS.TRAUMA CENTRE

15/08/2016 31/05/2018

53 1500000000990 PUSKESMAS KENTEN JL. MANGKUNEGARA NO. 1 KENTEN, KEC. ILIR TIMUR II DR. HJ. AGUSTINI PER/26/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

54 1500000000968 PUSKESMAS KERTAPATIJL. KOMPLEK SEMEN BATURAJA, KEC. KERTAPATI DR. ERINE DWINDA PER/12/052016

RS.TRAUMA CENTRE 15/08/2016 31/05/2018

55 1500000000968 PUSKESMAS KERTAPATI JL. KOMPLEK SEMEN BATURAJA, KEC. KERTAPATI

DR. ERINE DWINDA PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

56 1500000000963 PUSKESMAS KRAMASAN JL. ABIKUSNO COKRO SUYOSO LRG GOTONG ROYONG, KEC. KERTAPATI

DRG. ANDHIKA SITASARI PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

57 1500000000963 PUSKESMAS KRAMASANJL. ABIKUSNO COKRO SUYOSO LRG GOTONG ROYONG, KEC. KERTAPATI DRG. ANDHIKA SITASARI PER/12/052016

RS.TRAUMA CENTRE 15/08/2016 31/05/2018

58 1500000000959 PUSKESMAS MAKRAYU JL. MAKRAYU 32 ILIR, KEC. ILIR BARAT IIDR. HJ. NOVIA DIANA ROZA, M.KES PER/12/052016

RS.TRAUMA CENTRE 15/08/2016 31/05/2018

59 1500000000959 PUSKESMAS MAKRAYU JL. MAKRAYU 32 ILIR, KEC. ILIR BARAT IIDR. HJ. NOVIA DIANA ROZA, M.KES


01/06/2015 31/05/2016

60 1500000000978 PUSKESMAS MERDEKA JL. MERDEKA NO. 66 PALEMBANG, KEC. BUKIT KECIL

DR. HJ. DESTY ARYANI, M.KES


15/08/2016 31/05/2018


Periode : 01/01/2015 s/d 31/10/2016


115 / 44607-11-201606:23:31



IKS


61 1500000000978 PUSKESMAS MERDEKA JL. MERDEKA NO. 66 PALEMBANG, KEC. BUKIT KECIL

DR. HJ. DESTY ARYANI, M.KES PER/26/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

62 1500000001003 PUSKESMAS MULTIWAHANA

JL. MITRA RAYA BLOK H NO. 4858, KEC. SAKO DRG. KIKI AYU MARLINA PER/26/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

63 1500000001003 PUSKESMAS MULTIWAHANA

JL. MITRA RAYA BLOK H NO. 4858, KEC. SAKO

DRG. KIKI AYU MARLINA PER/12/052016 RS.TRAUMA CENTRE

15/08/2016 31/05/2018

64 1500000000970 PUSKESMAS NAGASWIDAK JL. A. YANI LR GUMAI RT 22, 14 ULU, KEC. SEBERANG ULU II

DRG. BENCAS NAINGGOLAN


01/06/2015 31/05/2016

65 1500000000970 PUSKESMAS NAGASWIDAK JL. A. YANI LR GUMAI RT 22, 14 ULU, KEC. SEBERANG ULU II

DRG. BENCAS NAINGGOLAN PER/12/052016 RS.TRAUMA

CENTRE 15/08/2016 31/05/2018

66 1500000000964 PUSKESMAS OPI DS. 15 ULU, KEC. SEBERANG ULU I DRG. M. ERWAN NAUPAL PER/12/052016RS.TRAUMA CENTRE 15/08/2016 31/05/2018

67 1500000000964 PUSKESMAS OPI DS. 15 ULU, KEC. SEBERANG ULU I DRG. M. ERWAN NAUPAL PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

68 1500000000976 PUSKESMAS PADANG SELASA

JL. PADANG SELASA BUKIT BESAR, KEC. ILIR BARAT I

DRG. LIZANNA FARIANTY Y


01/06/2015 31/05/2016

69 1500000000976PUSKESMAS PADANG SELASA

JL. PADANG SELASA BUKIT BESAR, KEC. ILIR BARAT I

DRG. LIZANNA FARIANTY Y PER/12/052016

RS.TRAUMA CENTRE 15/08/2016 31/05/2018

70 1500000000974 PUSKESMAS PAKJOJL. INSPEKTUR MARZUKI NO. 2240, KEC. ILIR BARAT I DRG. NINA AGUSTINA PER/26/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

71 1500000000974 PUSKESMAS PAKJOJL. INSPEKTUR MARZUKI NO. 2240, KEC. ILIR BARAT I

DRG. NINA AGUSTINA PER/12/052016RS.TRAUMA CENTRE

15/08/2016 31/05/2018

72 1500000000961 PUSKESMAS PEMBINA JL. A. YANI NO. 62 SILABERANTI, KEC. SEBERANG ULU I

DR. ERFIANA UMAR, M.KES


15/08/2016 31/05/2018


Periode : 01/01/2015 s/d 31/10/2016


116 / 44607-11-201606:23:31



IKS


73 1500000000961 PUSKESMAS PEMBINA JL. A. YANI NO. 62 SILABERANTI, KEC. SEBERANG ULU I

DR. ERFIANA UMAR, M.KES PER/26/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

74 1500000000972 PUSKESMAS PLAJU JL. DI PANJAITAN PLAJU ULU, KEC. PLAJU DR. HJ. RITA AGUSTINA, M.KES PER/12/052016 RS.TRAUMA

CENTRE 15/08/2016 31/05/2018

75 1500000000972 PUSKESMAS PLAJU JL. DI PANJAITAN PLAJU ULU, KEC. PLAJU DR. HJ. RITA AGUSTINA, M.KES


01/06/2015 31/05/2016

76 1500000001012 PUSKESMAS PUNTIKAYU JL. SRIJAYA KM 5.5, KEC. ALANG ALANG LEBAR

DR. NYAYU FAISAL PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

77 1500000001012 PUSKESMAS PUNTIKAYU JL. SRIJAYA KM 5.5, KEC. ALANG ALANG LEBAR DR. NYAYU FAISAL PER/12/052016 RS.TRAUMA

CENTRE 15/08/2016 31/05/2018

78 1500000000991PUSKESMAS SABOKINGKING

JL. SABOKINGKING NO. 13 RT. 1, KEC. ILIR TIMUR II

DR. HJ. ARINA WARDHANI PER/26/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

79 1500000000991 PUSKESMAS SABOKINGKING

JL. SABOKINGKING NO. 13 RT. 1, KEC. ILIR TIMUR II

DR. HJ. ARINA WARDHANI


15/08/2016 31/05/2018

80 1500000001004 PUSKESMAS SAKO JL. LEMATANG RAYA NO. 16 RT. 29 LEBONGGAJAH, KEC. SEMATANG BORANG

DR. HERAWATI PER/12/052016 RS.TRAUMA CENTRE

15/08/2016 31/05/2018

81 1500000001004 PUSKESMAS SAKOJL. LEMATANG RAYA NO. 16 RT. 29 LEBONGGAJAH, KEC. SEMATANG BORANG DR. HERAWATI PER/26/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

82 1500000000997 PUSKESMAS SEI SELINCAHJL. MAYOR ZEN SEI SELINCAH, KEC. KALIDONI DR. HJ. SRI MARIAWATI PER/12/052016

RS.TRAUMA CENTRE 15/08/2016 31/05/2018

83 1500000000997 PUSKESMAS SEI SELINCAHJL. MAYOR ZEN SEI SELINCAH, KEC. KALIDONI

DR. HJ. SRI MARIAWATI PER/26/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

84 1500000000984 PUSKESMAS SEKIP JL. AMPHIBI NO. 812 RT.09 RW.03, KEC. KEMUNING

DR. HJ. MAHYUNIS MAHMOEDDIN


15/08/2016 31/05/2018


Periode : 01/01/2015 s/d 31/10/2016


117 / 44607-11-201606:23:31



IKS


85 1500000000984 PUSKESMAS SEKIP JL. AMPHIBI NO. 812 RT.09 RW.03, KEC. KEMUNING

DR. HJ. MAHYUNIS MAHMOEDDIN PER/26/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

86 1500000001006 PUSKESMAS SOSIAL JL. SOSIAL KOMPLEK PSBD "BUDI PERKASI"KM. 5, KEC. SUKARAMI DR. MERIANCE PER/12/052016 RS.TRAUMA

CENTRE 15/08/2016 31/05/2018

87 1500000001006 PUSKESMAS SOSIAL JL. SOSIAL KOMPLEK PSBD "BUDI PERKASI"KM. 5, KEC. SUKARAMI

DR. MERIANCE PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

88 1500000001007 PUSKESMAS SUKARAME JL. KEBUN BUNGA RT. 37 NO. 1 KM. 9, KEC. SUKARAMI

DRG. PURNAMAWATI PER/12/052016 RS.TRAUMA CENTRE

15/08/2016 31/05/2018

89 1500000001007 PUSKESMAS SUKARAME JL. KEBUN BUNGA RT. 37 NO. 1 KM. 9, KEC. SUKARAMI DRG. PURNAMAWATI PER/26/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

90 1500000000975PUSKESMAS SUNGAI BAUNG

JL. PERTIWI RT.10 DWIKORA II, KEC. ILIR BARAT I DR. NURIN ERLYNDIA PER/12/052016

RS.TRAUMA CENTRE 15/08/2016 31/05/2018

91 1500000000975 PUSKESMAS SUNGAI BAUNG

JL. PERTIWI RT.10 DWIKORA II, KEC. ILIR BARAT I

DR. NURIN ERLYNDIA PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

92 1500000001011 PUSKESMAS TALANG BETUTU

JL. TALANG BETUTU, KEC. SUKARAMI DR. MSY MEIDIAWANI PER/12/052016 RS.TRAUMA CENTRE

15/08/2016 31/05/2018

93 1500000001011PUSKESMAS TALANG BETUTU JL. TALANG BETUTU, KEC. SUKARAMI DR. MSY MEIDIAWANI PER/26/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

94 1500000000981 PUSKESMAS TALANG RATUJL. TALANG RATU KM 5 ILIR D-IV, KEC. ILIRTIMUR I DRG. INDRIATI PER/12/052016

RS.TRAUMA CENTRE 15/08/2016 31/05/2018

95 1500000000981 PUSKESMAS TALANG RATUJL. TALANG RATU KM 5 ILIR D-IV, KEC. ILIRTIMUR I

DRG. INDRIATI PER/26/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

96 1500000000971 PUSKESMAS TAMAN BACAAN

JL. K.H. AZHARI TAMAN BACAAN, KEC. SEBERANG ULU II

DRG. ERMINDA PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


118 / 44607-11-201606:23:31



IKS


97 1500000000971 PUSKESMAS TAMAN BACAAN

JL. K.H. AZHARI TAMAN BACAAN, KEC. SEBERANG ULU II DRG. ERMINDA PER/12/052016 RS.TRAUMA

CENTRE 15/08/2016 31/05/2018

98 1500000000183 RS MUHAMMADIYAH PALEMBANG

JL A. YANI RT.028 RW. 001 KELURAHAN 13 ULU KECAMATAN SEBRANG ULU II 513144 DR. H. YUDI FADILAH,

SPPD, FINASIM PER/02/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

99 1500000000183 RS MUHAMMADIYAH PALEMBANG

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

513144 DR. H. YUDI FADILAH, SPPD, FINASIM


14/01/2016 31/12/2016

100 1400000000163 RS PELABUHAN PALEMBANG

JL MAYOR MEMET SASTRAWIRYA NO 01 BOOM BARU

712840 DR DEDY NUGROHO PER/01/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

101 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

102 1400000000165RS PERTAMINA PLAJU PALEMBANG JL PENGANTINGAN NO 1 KOMPERTA PLAJU

DR DODY ALAMSYAH SIREGAR PER/11/062016

RS.TRAUMA CENTRE 24/06/2016 31/05/2018

103 1400000000165 RS PERTAMINA PLAJU PALEMBANG

JL PENGANTINGAN NO 1 KOMPERTA PLAJU DR DODY ALAMSYAH SIREGAR


29/04/2015 31/03/2016

104 7-299935347 RS RK CHARITAS JL. JNEDRAL SUDIRMAN NO 1054 30129 PROF DR HARDI DARMAWAN


14/06/2016 28/02/2019

105 1400000000200 RS TK II DR AK GANI JL DR AK GANI NO 01DR MADE WIRAYASA TUSAN PER/21/062015

RS.TRAUMA CENTRE 20/06/2015 31/05/2016

106 1400000000200 RS TK II DR AK GANI JL DR AK GANI NO 01DR MADE WIRAYASA TUSAN PER/10/052016

RS.TRAUMA CENTRE 15/06/2016 31/05/2018

107 1500000000597 RSIA SITI MIRZA JL. DEMANG LEBAR DAUN (SAMPING BANK BCA DEMANG LEBAR DAUN PALEMBANG)

446272 PT. DWI JAYA SERASI PER/12/042015RS.TRAUMA CENTRE

01/04/2015 31/03/2016

108 1500000000686 RSIA YK MADIRA JL. JENDRAL SUDIRMAN 1051 C-D-E 364954 YAYASAN YK MAIRA PER/07/052016 RS.TRAUMA CENTRE

15/06/2016 31/03/2017


Periode : 01/01/2015 s/d 31/10/2016


119 / 44607-11-201606:23:31



IKS


109 1500000000686 RSIA YK MADIRA JL. JENDRAL SUDIRMAN 1051 C-D-E 364954 YAYASAN YK MAIRA PER/11/042015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

110 1500000000926 RSK DR RIVAI ABDULLAH PALEMBANG

JL. SUNGAI KUNDUR KELURAHAN MARIANA KECAMATAN BANYUASIN 1 KEMENKES PER/20/052015 RS.TRAUMA

CENTRE 01/04/2015 31/12/2016

111 1500000000300 RSUD KAYU AGUNG JALA. MARZUKI ZAHRI NO.1037 CINTARAJAKAYUAGUNG

323889 RSUD KAYU AGUNG PER/04/032015 RS.TRAUMA CENTRE

01/03/2015 28/02/2016

112 1500000000509 RSUD SEKAYUJALAN KOLONEL WAHID UDIN LINGKUNGAN 1 KELURAHAN KAYUARA SEKAYU

321855 DR IRA PER/13/062016 RS.TRAUMA CENTRE

22/09/2016 31/05/2018

113 1500000000509 RSUD SEKAYUJALAN KOLONEL WAHID UDIN LINGKUNGAN 1 KELURAHAN KAYUARA SEKAYU

321855 DR IRA PER/09/042015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

114 7-3923671503RSUP DR. MOHAMMAD HOESIN

JL. JEND. SUDIRMAN, SEKIP JAYA, ILIR TIM.I, KOTA PALEMBANG, SUMATERA SELATAN

30126 00354088 KEMENKES PER/16/062016RS.TRAUMA CENTRE 24/06/2016 19/06/2018

115 1400000000167RUMAH SAKIT BHAYANGKARA PALEMBANG

JL JEND SUDIRMAN KM 4,5 PALEMBANG DR SYAMSUL BAHAR PER/28/062015 RS.TRAUMA CENTRE

05/06/2015 31/05/2016

116 1400000000167RUMAH SAKIT BHAYANGKARA PALEMBANG

JL JEND SUDIRMAN KM 4,5 PALEMBANG DR SYAMSUL BAHAR PER/12/062016 RS.TRAUMA CENTRE

24/06/2016 31/05/2018

117 1500000000705RUMAH SAKIT BUNDA PALEMBANG

JALAN DEMANG LEBAR DAUN NO. 70 PALEMBANG 311866 YAYASAN BUNDA PER/08/052016

RS.TRAUMA CENTRE 16/06/2016 30/04/2018

118 1500000000705RUMAH SAKIT BUNDA PALEMBANG

JALAN DEMANG LEBAR DAUN NO. 70 PALEMBANG 311866 YAYASAN BUNDA PER/07/042015

RS.TRAUMA CENTRE 01/04/2015 30/04/2016

119 7-4000185483RUMAH SAKIT ERNALDI BAHAR PROVINSI SUMATERA SELATAN

JL. TEMBUS TERMINAL NO. 2 KM. 12 KELURAHAN ALANG – ALANG LEBAR PALEMBANG

30961 05645126PEMPROV SUMATERA SELATAN


30/06/2016 31/05/2018

120 7-3987557456RUMAH SAKIT KHUSUS GIGIDAN MULUT PROVINSI SUMATERA SELATAN

JL. KOL. H. BURLIAN KM. 6 PALEMBANG 30151 05610491 PEMPROV SUMATERA SELATAN


29/06/2016 31/05/2018


Periode : 01/01/2015 s/d 31/10/2016


120 / 44607-11-201606:23:31



IKS


121 7-3987204883RUMAH SAKIT KHUSUS MATA PROVINSI SUMATERASELATAN

JL. KOL. H. BURLIAN KM. 6 PALEMBANG 30151 005612838 PEMPROV SUMATERA SELATAN PER/22/062016 RS.TRAUMA

CENTRE 29/06/2016 31/05/2018

122 1500000000928RUMAH SAKIT KHUSUS PARU PROVINSI SUMATERA SELATAN

JL. MERDEKA NOMOR 10 PALEMBANG PER /17/062016 RS.TRAUMA CENTRE 29/06/2016 31/12/2018

123 1500000000928RUMAH SAKIT KHUSUS PARU PROVINSI SUMATERA SELATAN

JL. MERDEKA NOMOR 10 PALEMBANG PER/13/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

124 1400000000236 RUMAH SAKIT MYRIA PALEMBANG

JL KOL H BURLIAN NO 228 PALEMBANG DR F X INDRA SETIADI MARS


15/06/2016 31/05/2018

125 1400000000236 RUMAH SAKIT MYRIA PALEMBANG JL KOL H BURLIAN NO 228 PALEMBANG DR F X INDRA SETIADI

MARS PER/24/062015 RS.TRAUMA CENTRE 11/06/2015 31/05/2016

126 1500000001101UPTD BLK INDUSTRI DISNAKERTRANS JL. RESIDEN H AMALUDDIN SAKO KENTEN PER/02/012016

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

127 1500000001101 UPTD BLK INDUSTRI DISNAKERTRANS

JL. RESIDEN H AMALUDDIN SAKO KENTEN PER/03/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

KANTOR CABANG : G01- KANTOR CABANG BENGKULU


IKS


1 7-4218224133BP MAKO LANAL BENGKULU

JL. RE MARTADINATA KOTA BENGKULU 38116 TNI AL BENGKULU PER/12/072016RS.TRAUMA CENTRE

29/07/2016 31/12/2018

2 1500000000414 KLINIK BETESDA JL. LINTAS PAGAR ALAM DESA PERMU IMIGRASI

ROSMAWATI PURBA PER/08/032015 RS.TRAUMA CENTRE

01/03/2015 28/02/2017


Periode : 01/01/2015 s/d 31/10/2016


121 / 44607-11-201606:23:31



IKS


3 7-4698836813 KLINIK BUAH HATI JLN BALTI SISWA KEL BATU GADING KEC CURUP TENGAH 39113 SULISTIAWATI PER/17/092016 RS.TRAUMA

CENTRE 13/09/2016 31/12/2018

4 1500000000415 KLINIK MEDISTRA JL. S PARMAN RT.01 RW.01 KEL. TANAH PATAH ICHSANA PRANATAWATI PER/09/022015 RS.TRAUMA

CENTRE 01/02/2015 31/01/2017

5 1500000000650 KLINIK PRATAMA GUNUNG BUNGKUK MEDIKA

JALAN ROKAN KIRI NO.1 KEL. PADANG HARAOAN KEC. GADING CEMPAKA

PEMERINTAH PROVINSI BENGKULU


01/05/2015 30/04/2017

6 1500000000862 PKM KEMBANG SERI JALAN RAYA BENGKULU-CURUP KM. 14 BENGKULU TENGAH

PEMKAB BENGKULU TENGAH


01/05/2015 30/04/2017

7 7-4237340443 PUSKESMAS JALAN GEDANG JL. P NATADIRJA KM. 7,5 38221 PEMKOT BENGKULU PER/11/072016 RS.TRAUMA

CENTRE 01/08/2016 31/12/2018

8 1500000000298RS BHAYANGKARA TK III BENGKULU JL. VETERAN NO.02 BENGKULU 341086 POLRI PER/02/022015

RS.TRAUMA CENTRE 01/02/2015 31/01/2017

9 1500000000298 RS BHAYANGKARA TK III BENGKULU

JL. VETERAN NO.02 BENGKULU 341086 POLRI PER/02/022015 RS.TRAUMA CENTRE

01/02/2015 31/01/2017

10 7-4990668833RS KHUSUS JIWA SOEPRAPTO PROVINSI BENGKULU

JL. BHAKTI HUSADA LINGKAR BARAT 38225 PEMPROV BENGKULU PER/18/092016 RS.TRAUMA CENTRE

29/09/2016 31/12/2018

11 7-4247630044 RS RAFFLESIA BENGKULU JALAN MAHONI KOTA BENGKULU 38227 YAYASAN RAFFLESIA PER/14/082016RS.TRAUMA CENTRE 02/08/2016 31/12/2018

12 7-5023843991 RS TIARA SELLA JL. SPARMAN NO 61 PADANG JATI 38223 PT. GRAHA BERNOZA PER/19/102016RS.TRAUMA CENTRE 03/10/2016 31/12/2018

13 1500000000982RS TK IV 02.07.01 ZAINUL ARIFIN

JL. ZAINAL ARIFIN GADING CEMPAKA 21048 KODAM II SRIWIJAYA PER/11/052015RS.TRAUMA CENTRE

01/05/2015 30/04/2017

14 1500000000982 RS TK IV 02.07.01 ZAINUL ARIFIN

JL. ZAINAL ARIFIN GADING CEMPAKA 21048 KODAM II SRIWIJAYA PER/11/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2017


Periode : 01/01/2015 s/d 31/10/2016


122 / 44607-11-201606:23:31



IKS


15 7-4319662053 RSU UMMI BENGKULU JALAN HIBRIDA SIDOMULYO 38221 YAYASAN RIDHO MANDIRI PER/13/072016 RS.TRAUMA

CENTRE 09/08/2016 31/12/2017

16 1500000001315 RSUD ARGA MAKMUR JALAN SITI KHADIJAH NO.08 ARGA MAKAMUR 521118 DR. JASMEN SILITONGA

M.KES SPKK PER/17/052015 RS.TRAUMA CENTRE 01/05/2015 30/04/2017

17 1500000000945 RSUD BENGKULU TENGAH JL. RAYA BENGKULU-KEPAHIANG KM.34,5 BAJAK 1

75683474 PEMKAB BENGKULU TENGAH

PER/19/05/052015

RS.TRAUMA CENTRE

01/05/2015 30/04/2017

18 7-3455468930 RSUD DR M YUNUS JALAN BAYANGKARA BENGKULU 38221 PEMPROV BENGKULU PER/03/032016 RS.TRAUMA CENTRE

19/05/2016 31/03/2017

19 1500000000468 RSUD DR. M YUNUS JL BHAYANGKARA BENGKULU 52004 DR. H. SYAFRIADI PER/02/032015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

20 7-4220572323 RSUD KEPAHIANGJALAN LINTAS KEPAHIANG KM. 03 DESA TEBAT MONOK 39372 PEMKAB KEPAHIANG PER/10/072016

RS.TRAUMA CENTRE 29/07/2016 31/12/2018

21 7-3876847207 RSUD KOTA BENGKULU JALAN BASUKI RAHMAT NO 1 38224 PEMKOT BENGKULU PER/06/062016 RS.TRAUMA CENTRE

21/06/2016 31/05/2018

22 1500000000533 RSUD MUKOMUKO JALAN DANAU NIBUNG DESA KOTA PRAJA 71148PEMERINTAH KABUPATEN MUKOMUKO


01/01/2015 31/12/2018

KANTOR CABANG : G02- KANTOR CABANG PANGKAL PINANG


IKS


1 1500000000601 BIDDOKKES POLDA KEP. BANGKA BELITUNG

JL MERDEKA NO 12 PANGKALPINANG PER/06/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


123 / 44607-11-201606:23:31



IKS


2 1500000001511 BLK PROVINSI KEPULAUAN BANGKA BELITUNG

AIR ITAM, KOMPLEK PERKANTORAN GUBERNUR PROVINSI KEPULAUAN BANGKA BELITUNG

DISNAKER PROVINSI KEPULAUAN BANGKA BELITUNG


3 1400000000730 BPRB MEDIKA STANNIA BELINYU YAYASAN BAKTI TIMAH PER/001/122015 RS.TRAUMA CENTRE 29/01/2016 29/02/2016

4 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

5 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

6 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

7 7-5025548207 KLINIK INTAN MEDIKAJL GIOK I NO.77 KEL.BATU INTAN PANGKALPINANG 33115 434099000 DR. HENDRY JAN PER/18/102016

RS.TRAUMA CENTRE 03/10/2016 30/04/2017

8 1500000001400 KLINIK INTAN MEDIKA JL GIOK NO 77 KEL BUKIT INTAN KEC BUKIT INTAN PANGKALPINANG

434099 DR. HENDRI JAN PER/019/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

9 1500000001509 KLINIK PRATAMA BAKTI TIMAH

YAYASAN BAKTI TIMAH PER/022/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

10 1500000001452KLINIK UTAMA TANJUNG PANDAN TANJUNG PANDAN DR YUSTINUS PER/023/072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

11 1500000000612 PUSKESMAS BAKAMJL. RAYA PANGKAL PINANG - MENTOK KM 38 DESA BAKAM KEC BAKAM H. SOFIANDI, SKM, M. SI PER/07/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

12 1500000000609 PUSKESMAS BATU RUSA JALAN RAYA BATU RUSA KAB BANGKA H. SOFIANDI, SKM, M. SI PER/07/052015RS.TRAUMA CENTRE

01/05/2015 30/04/2016

13 1500000000617 PUSKESMAS BELINYU JL DEPATI BARIN BELINYU BANGKA H. SOFIANDI, SKM, M. SI PER/07/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


124 / 44607-11-201606:23:31



IKS


14 7-5137288993 PUSKESMAS BENTENG JL TITIAN PUSPA NO.06 KEL.PADANG MULIA KEC.KOBA BANGKA TENGAH 33681 PEMERINTAH DAERAH

BANGKA TENGAH441.9/7244/DINKES/2016

RS.TRAUMA CENTRE 12/10/2016 31/12/2017

15 1500000001548 PUSKESMAS BENTENG JL BATU BELUBANG DUSUN BENTENG KEC PANGKALAN BARU PER/024/072015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

16 1500000000616 PUSKESMAS GUNUNG MUDA

BELINYU H. SOFIANDI, SKM, M. SI PER/07/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

17 1500000001501 PUSKESMAS JEBUS JLN. KAMPAK NO.188 NO.188 DESA JEBUS, KEC. JEBUS


01/06/2015 31/05/2016

18 1500000001499 PUSKESMAS KELAPA JLN. RAYA KELAPA TIMUR, KEL. KELAPA, KEC. KELAPA PER/020/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

19 1500000000607 PUSKESMAS KENANGA SUNGAILIAT H. SOFIANDI, SKM, M. SI PER/07/052015RS.TRAUMA CENTRE 01/05/2015 30/04/2016

20 7-5138184037 PUSKESMAS KOBA JL TITIAN PUSPA NO.06 KEL.PADANG MULIA KEC.KOBA BANGKA TENGAH

33681 PEMKAB BATENG 441.9/7244/DINKES/2016

RS.TRAUMA CENTRE

12/10/2016 31/12/2017

21 1500000001549 PUSKESMAS KOBA JL POS KOBA KEL KOBA KEC KOBA PER/024/072015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

22 1500000001498 PUSKESMAS KUNDIJLN. BARU, DUSUN III, DESA KUNDI, KEC. SP.TERITIP PER/020/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

23 7-5138184033 PUSKESMAS LAMPURJL TITIAN PUSPA NO.06 KEL.PADANG MULIA KEC.KOBA BANGKA TENGAH 33681

PEMKAB BANGKA TENGAH

441.9/7244/DINKES/2016

RS.TRAUMA CENTRE 12/10/2016 31/12/2017

24 1500000001547 PUSKESMAS LAMPUR JL RAYA LAMPUR KEC SUNGAI SELAN PER/024/072015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

25 7-5138184039 PUSKESMAS LUBUK JL TITIAN PUSPA NO.06 KEL.PADANG MULIA KEC.KOBA BANGKA TENGAH


RS.TRAUMA CENTRE

12/10/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


125 / 44607-11-201606:23:31



IKS


26 1500000001550 PUSKESMAS LUBUK JL RAYA LUBUK BESAR DS LUBUK BESAR KEC KOBA PER/024/072015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

27 1500000001496 PUSKESMAS MUNTOK JLN. BASUKI RAHMAT, KEL. SUNGAI DAENG, KEC. MUNTOK PER/020/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

28 1500000001544 PUSKESMAS NAMANG JL RAYA NAMANG DUSUN KOBA PANGKALAN BARU


01/07/2015 30/06/2016

29 7-5138797765 PUSKESMAS NAMANG JL TITIAN PUSPA NO.06 KEL.PADANG MULIA KEC.KOBA BANGKA TENGAH


RS.TRAUMA CENTRE

12/10/2016 31/12/2017

30 7-5138797761 PUSKESMAS PANGKALAN BARU

JL TITIAN PUSPA NO.06 KEL.PADANG MULIA KEC.KOBA BANGKA TENGAH 33681 PEMKAB BANGKA

TENGAH441.9/7244/DINKES/2016

RS.TRAUMA CENTRE 12/10/2016 31/12/2017

31 1500000001543PUSKESMAS PANGKALAN BARU

JL RAYA KOBA DUSUN BELULUK PANGKALAN BARU PER/024/072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

32 1500000000614 PUSKESMAS PEMALI PEMALI - BANGKA H. SOFIANDI, SKM, M. SI PER/07/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

33 1500000000611 PUSKESMAS PENAGAN MENDO BARAT H. SOFIANDI, SKM, M. SI PER/07/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

34 1500000000610 PUSKESMAS PETALINGJLN RAYA PANGKAL PINANG MENTOK KM DESA PETALING KEC MENDO BARAT KAB BANGKA

H. SOFIANDI, SKM, M. SI PER/07/052015RS.TRAUMA CENTRE 01/05/2015 30/04/2016

35 1500000000613 PUSKESMAS PUDING BESAR PUDING BESAR H. SOFIANDI, SKM, M. SI PER/07/052015RS.TRAUMA CENTRE 01/05/2015 30/04/2016

36 1500000001502 PUSKESMAS PUPUT JL. PASAR PARIT III DS. PUPUT, KEC. JEBUS PER/020/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

37 1500000000615 PUSKESMAS RIAU SILIP RIAU SILIP H. SOFIANDI, SKM, M. SI PER/07/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


126 / 44607-11-201606:23:31



IKS


38 1500000001503 PUSKESMAS SEKAR BIRU JL. TAMBANG KERING DS. SEKAR BIRU, KEC. JEBUS PER/020/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

39 7-5138184035 PUSKESMAS SIMPANG KATIS

JL TITIAN PUSPA NO.06 KEL.PADANG MULIA KEC.KOBA BANGKA TENGAH 33681 PEMKAB BATENG 441.9/7244/DIN

KES/2016RS.TRAUMA CENTRE 12/10/2016 31/12/2017

40 1500000001545 PUSKESMAS SIMPANG KATIS

JL RAYA SUNGAI SELAN DUSUN SIMPANG KATIS KEC SIMPANG KATIS


01/07/2015 30/06/2016

41 1500000001497 PUSKESMAS SIMPANG TERITIP

JLN. POROS MUNTOK- PANGKALPINANG, KEC. SP. TERITIP


01/06/2015 30/05/2016

42 1500000000608 PUSKESMAS SINAR BARU SUNGAILIAT H. SOFIANDI, SKM, M. SI PER/07/052015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

43 1500000001546 PUSKESMAS SUNGAI SELANJL BATIN TIKAL DUSUN SUNGAI SELAN KEC SUNGAI SELAN PER/024/072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

44 7-5138797763 PUSKESMAS SUNGAI SELAN JL TITIAN PUSPA NO.06 KEL.PADANG MULIA KEC.KOBA BANGKA TENGAH


RS.TRAUMA CENTRE

12/10/2016 31/12/2017

45 1500000000606 PUSKESMAS SUNGAILIAT JL JEND SUDIRMAN SUNGALIAT BANGKA H. SOFIANDI, SKM, M. SI PER/07/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

46 1500000001500 PUSKESMAS TEMPILANGJL. PANGLIMA ANGIN NO. 20 DS. TEMPILANG, KEC. TEMPILANG PER/020/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

47 1400000000112 RS ALMAHJL. JEND. SUDIRMAN DESA BULUH TUMBANG DUSUN PERAWAS II RT 3 RW 2 TANJUNG PANDAN

HIDAYAT ARSANI PER/015/052015RS.TRAUMA CENTRE 01/05/2015 30/04/2016

48 1400000000098 RS ARSANI JL RAYA KENANGA SUNGAILIAT 4297825 PER/06/042016RS.TRAUMA CENTRE

17/06/2016 31/03/2017

49 1400000000098 RS ARSANI JL RAYA KENANGA SUNGAILIAT 4297825 PER/05/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016


Periode : 01/01/2015 s/d 31/10/2016


127 / 44607-11-201606:23:31



IKS


50 1400000000097 RS BAKTI TIMAH JL JEND SUDIRMAN KEC TAMAN SARI PANGKALPINANG YAYASAN BAKTI TIMAH PER/02/072016 RS.TRAUMA

CENTRE 22/09/2016 21/09/2016

51 1400000000097 RS BAKTI TIMAH JL JEND SUDIRMAN KEC TAMAN SARI PANGKALPINANG YAYASAN BAKTI TIMAH PER/17/092016 RS.TRAUMA

CENTRE 28/09/2016 31/12/2017

52 1400000000097 RS BAKTI TIMAH JL JEND SUDIRMAN KEC TAMAN SARI PANGKALPINANG


01/05/2015 30/04/2016

53 1400000000097 RS BAKTI TIMAH JL JEND SUDIRMAN KEC TAMAN SARI PANGKALPINANG


27/07/2016 31/07/2016

54 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

55 1400000000091 RS BHAKTI WARA JL. SUNGAI SELAN KM.4 PANGKALPINANG 422605YAYASAM TUNAS KARYA PER/06/042016

RS.TRAUMA CENTRE 29/08/2016 30/04/2017

56 1400000000091 RS BHAKTI WARA JL. SUNGAI SELAN KM.4 PANGKALPINANG 422605 YAYASAM TUNAS KARYA


01/05/2015 30/04/2016

57 7-3617755362 RSUD BANGKA SELATAN JL RAYA GADUNG 33783PEMERINTAH KABUPATEN BANGKA SELATAN


02/06/2016 30/04/2017

58 7-4207349783 RSUD BANGKA TENGAH JL BY PASS KOBA, BANGKA TENGAH 33681DR. HJ. DEDE LINA LINDAYANTI PER/14/072016

RS.TRAUMA CENTRE 01/08/2016 31/07/2017

59 1500000000602 RSUD BELITUNG TIMUR JL RAYA GANTUNG DS PADANG MANGGAR PER/6/042016RS.TRAUMA CENTRE 07/09/2016 30/04/2017

60 1500000000602 RSUD BELITUNG TIMUR JL RAYA GANTUNG DS PADANG MANGGAR PER/08/052015RS.TRAUMA CENTRE

01/05/2015 30/04/2016

61 1400000000089 RSUD DEPATI HAMZAH PANGKAL PINANG

JL MAYOR SYAFRIE RACHMAN PANGKAL PINANG


01/04/2015 31/03/2016


Periode : 01/01/2015 s/d 31/10/2016


128 / 44607-11-201606:23:31



IKS


62 1400000000089 RSUD DEPATI HAMZAH PANGKAL PINANG

JL MAYOR SYAFRIE RACHMAN PANGKAL PINANG

PER / 04 / 042016

RS.TRAUMA CENTRE 17/06/2016 31/03/2017

63 7-4238540843 RSUD DR (HC) IR SOEKARNO JL ZIPUR DESA AIR ANYIR KEC.MERAWANG BANGKA 00000 DR LUCIA SHINTA

SILALAHI, MARS PER/12/072016 RS.TRAUMA CENTRE 01/08/2016 31/07/2017

64 7-3838464310 RSUD DR EKO MAULANA ALI

JL RAYA BELINYU, DUSUN CANGKUM, DESA RIDING PANJANG

33253 PEMERINTAH DAERAH KAB BANGKA


17/06/2016 30/04/2017

65 7-3838983832 RSUD SEJIRAN SETASON JL KADUR DALAM MUNTOK, BANGKA BARAT

33311 PEMERINTAH DAERAH KAB BANGKA BARAT


17/06/2016 31/03/2017

66 1400000000729 RUMAH SAKIT MEDIKA STANNIA JL. JEND. SUDIRMAN NO. 03 SUNGAILIAT 95837 YAYASAN BAKTI TIMAH PER/05/032016 RS.TRAUMA

CENTRE 17/06/2016 28/02/2017

67 1400000000729RUMAH SAKIT MEDIKA STANNIA JL. JEND. SUDIRMAN NO. 03 SUNGAILIAT 95837 YAYASAN BAKTI TIMAH PER/001/122015

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

68 1500000000619SPGD (SISTEM PENANGGULANGAN GAWATDARURAT)

SUNGAILIAT H. SOFIANDI, SKM, M. SI PER/07/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

69 1500000001398 SUN CLINIC EL JOHN JL SOEKARNO HATTA NO 208 PANGKALPINANG


01/06/2015 31/05/2016

KANTOR CABANG : G03- KANTOR CABANG MUARA ENIM


IKS


1 1500000001075 KLINIK 3F MEDIKA JL PUNCAK II NO 748 RT 03/03 GUMAWANG BELITANG

451299 DR HJ TRIKANDIANI PER/37/052015 RS.TRAUMA CENTRE

25/05/2015 24/05/2016


Periode : 01/01/2015 s/d 31/10/2016


129 / 44607-11-201606:23:31



IKS


2 1500000000763 KLINIK FADHILAH PT TEL DI DESA NIRU KEC RAMBANG DANGKU 24102380 DR ASRI RAHMAT PER/28/042014 RS.TRAUMA

CENTRE 10/03/2016 25/01/2017

3 1500000000763 KLINIK FADHILAH PT TEL DI DESA NIRU KEC RAMBANG DANGKU 24102380 DR ASRI RAHMAT PER/28/042014 RS.TRAUMA

CENTRE 05/05/2015 04/05/2016

4 1500000000764 KLINIK FMC 24 JAM JL PADAT KARYA KELURAHAN GUNUNG IBUL

68044521 DR TRISNAYANTI PER/29/042015 RS.TRAUMA CENTRE

10/03/2016 25/01/2017

5 1500000000764 KLINIK FMC 24 JAM JL PADAT KARYA KELURAHAN GUNUNG IBUL

68044521 DR TRISNAYANTI PER/29/042015 RS.TRAUMA CENTRE

05/05/2015 04/05/2016

6 1500000001232 PUSKESMAS PAJAR BULAN DS PAJAR BULAN , KEC SEMENDO DARAT ULU KAB MUARA ENIM 31355 69870030 H. HAIRIL JONSON, SKM PER/44/062015 RS.TRAUMA

CENTRE 08/06/2015 07/06/2016

7 1500000001232 PUSKESMAS PAJAR BULANDS PAJAR BULAN , KEC SEMENDO DARAT ULU KAB MUARA ENIM 31355 69870030 H. HAIRIL JONSON, SKM PER/44/062015

RS.TRAUMA CENTRE 31/05/2016 25/01/2017

8 7-4589523056 PUSKESMAS ABAB JL RAYA BETUNG, KECAMATAN ABAB 00000 ENI HARTINA, AM.KEB PER/53/082016 RS.TRAUMA CENTRE

31/08/2016 31/12/2017

9 7-4589323924 PUSKESMAS AIR ITAM JL PERINTIS KEMERDEKAAN, DESA AIR ITAM KECAMATAN PENUKAL

00000 MARLINA, AM.KEP PER/53/082016 RS.TRAUMA CENTRE

31/08/2016 31/12/2017

10 1500000001505PUSKESMAS GELUMBANG KAB. MUARA ENIM DS GELUMBANG KEC. GELUMBANG 73610770 MUSADAT, SKM PER/28/042016

RS.TRAUMA CENTRE 17/06/2016 01/04/2017

11 1500000001505PUSKESMAS GELUMBANG KAB. MUARA ENIM DS GELUMBANG KEC. GELUMBANG 73610770 MUSADAT, SKM PER/46/062015

RS.TRAUMA CENTRE 15/06/2015 14/06/2016

12 7-3563873123 PUSKESMAS LEMBAK JL RAYA PLG-PBM NO. 11 LEMBAK 31171 WARNIATI, SKM PER/27/042016RS.TRAUMA CENTRE

31/05/2016 01/04/2017

13 7-3100567197 PUSKESMAS PULAU PANGGUNG

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

26/04/2016 01/03/2017


Periode : 01/01/2015 s/d 31/10/2016


130 / 44607-11-201606:23:31



IKS


14 7-4588916503 PUSKESMAS SIMPANG BABAT

JL SIMPANG BELIMBING-SEKAYU DESA BABAT 00000 WANTORO, SKM, M.KES PER/53/082016 RS.TRAUMA

CENTRE 31/08/2016 31/12/2017

15 7-4585921204 PUSKESMAS SUNGAI BAUNG

JL RAYA BENAKAT-PENDOPO DUSUN II DESA SUNGAI BAUNG KEC. TALANG UBI 00000 DR RONALD APRINALDI PER/53/082016 RS.TRAUMA

CENTRE 31/08/2016 31/12/2017

16 7-4585887903 PUSKESMAS TALANG UBI JL TALANG ANDING KELURAHAN TALANG UBI TIMUR

00000 DRG HJ FERY SEPTARINI PER/53/082016 RS.TRAUMA CENTRE

31/08/2016 31/12/2017

17 7-4586077817 PUSKESMAS TANAH ABANG JL PERTAMINA PENGABUAN- TANAH ABANG JAYA

00000 FAISAL AL-MUSLIM, SKM PER/53/082016 RS.TRAUMA CENTRE

31/08/2016 31/12/2017

18 7-3534949795 PUSKESMAS TANJUNG AGUNG JL BATURAJA NO 456 31355 DAUD KAMALUDIN, SKM PER/34/042016 RS.TRAUMA

CENTRE 26/05/2016 01/04/2017

19 1500000001231PUSKESMAS TANJUNG RAYA

DS TANJUNG RAYA KEC SEMENDO DARAT TENGAH 73720427 ELYA SUSITA, SKM PER/45/062015

RS.TRAUMA CENTRE 08/06/2015 07/06/2016

20 1500000001231 PUSKESMAS TANJUNG RAYA

DS TANJUNG RAYA KEC SEMENDO DARAT TENGAH

73720427 ELYA SUSITA, SKM PER/45/062015 RS.TRAUMA CENTRE

17/03/2016 25/01/2017

21 7-4589404905 PUSKESMAS TEMPIRAI JL RAYA TEMPIRAI SELATAN PRABU MENANG, KECAMATAN PENUKAL UTARA

00000 SUSILAWATI, AM. KEP PER/53/082016 RS.TRAUMA CENTRE

31/08/2016 31/12/2017

22 1500000000498RS AR BUNDA LUBUKLINGGAU

JL GARUDA NO 245 RT 3 KEL BANDUNG KIRI KEC LUBUKLINGGAU BARAT I 324963

DR SARAH AINAR RAHMAN PER/38/042016

RS.TRAUMA CENTRE 13/07/2016 01/04/2017

23 1500000000498RS AR BUNDA LUBUKLINGGAU

JL GARUDA NO 245 RT 3 KEL BANDUNG KIRI KEC LUBUKLINGGAU BARAT I 324963

DR SARAH AINAR RAHMAN PER/14/042015

RS.TRAUMA CENTRE 13/04/2015 12/04/2016

24 1500000000599 RS AR BUNDA PRABUMULIHJL ANGKATAN 45 NO 525 KELURAHAN GUNUNG IBUL

322954 DR H ALIP YANSON PER/19/042015RS.TRAUMA CENTRE

10/03/2016 25/01/2017

25 1500000000599 RS AR BUNDA PRABUMULIH JL ANGKATAN 45 NO 525 KELURAHAN GUNUNG IBUL

322954 DR H ALIP YANSON PER/19/042015 RS.TRAUMA CENTRE

13/04/2015 12/04/2016


Periode : 01/01/2015 s/d 31/10/2016


131 / 44607-11-201606:23:31



IKS


26 1500000001113 RS BUKIT ASAM MEDIKA JL RAYA BUKIT ASAM NO 118 TANJUNG ENIM

DR. PRAMADHYA BACHTIAR, M.KES PER/40/052015 RS.TRAUMA

CENTRE 25/05/2015 24/05/2016

27 1500000001113 RS BUKIT ASAM MEDIKA JL RAYA BUKIT ASAM NO 118 TANJUNG ENIM

DR. PRAMADHYA BACHTIAR, M.KES PER/40/052015 RS.TRAUMA

CENTRE 18/05/2016 25/01/2017

28 1500000000639 RS DR SOBIRIN JL YOS SUDARSO NO 13 LUBUK LINGGAU 321013 KAB.MUSI RAWAS PER/16/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

29 1500000000639 RS DR SOBIRIN JL YOS SUDARSO NO 13 LUBUK LINGGAU 321013 KAB.MUSI RAWAS PER/37/042016 RS.TRAUMA CENTRE

22/06/2016 31/03/2017

30 1500000000750 RS PANTI BHAKTININGSIH CHARITAS BELITANG JL TEGAL REJO BK X BELITANG 824244 YAYASAN

BHAKTININGSIH PER/31/052015 RS.TRAUMA CENTRE 11/05/2015 10/05/2016

31 1400000000192RS PERTAMINA PRABUMULIH

JL. KESEHATAN NO. 100 KOMPERTA PRABUMULIH 382742

DR. FIDI HENDRA ANWAR PER/21/04/2015

RS.TRAUMA CENTRE 01/05/2015 12/04/2016

32 1400000000192 RS PERTAMINA PRABUMULIH

JL. KESEHATAN NO. 100 KOMPERTA PRABUMULIH

382742 DR. FIDI HENDRA ANWAR


05/04/2016 25/01/2017

33 1500000000912 RS RUMKIT TK IV DR NOESMIR BATURAJA

JL DR MOH HATTA NO 64 BATURAJA 320123 OKU PER/30/052015 RS.TRAUMA CENTRE

11/05/2015 10/05/2016

34 1500000000535 RS SANTO ANTONIOJL KOMISARIS UMAR NO 33, BATURAJA 32121 320395

YAYASAN SANTO GEORGIUS PER/35/042015

RS.TRAUMA CENTRE 13/04/2015 12/04/2016

35 1500000001082RS TNI AD TK/IV.02.07.02 LAHAT JL MAYOR RUSLAN I LAHAT TNI AD LAHAT PER/35/052015

RS.TRAUMA CENTRE 18/05/2015 17/05/2016

36 1500000001073RSUD BASEMAH KOTA PAGAR ALAM

JL AIS NASUTION NO.03 PAGAR ALAM KAB PAGAR ALAM PER/38/052015RS.TRAUMA CENTRE

25/05/2015 24/05/2016

37 1500000000760 RSUD DR H IBNU SUTOWO JL MOH HATTA NO 1 BATURAJA 320298 KAB OKU PER/33/052015 RS.TRAUMA CENTRE

11/05/2015 10/05/2016


Periode : 01/01/2015 s/d 31/10/2016


132 / 44607-11-201606:23:31



IKS


38 1400000000122 RSUD HM RABAIN SULTAN MAHMUD BADARUDIN II NO. 49 424345 PER/12/012016 RS.TRAUMA CENTRE 10/03/2016 25/01/2017

39 1500000000645 RSUD LAHAT JL LETJEN HARUN SOHAR I NO 28 LAHAT 21785 LAHAT PER/27/042015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

40 1500000000536 RSUD MARTAPURA JL LETNAN MUCHTAR NO 185 TEBAT SARI 481004 PEMDA OKU TIMUR PER/22/042015 RS.TRAUMA CENTRE

13/04/2015 12/04/2016

41 1500000000738 RSUD MUARA DUA JL RANAU DESA SUKAJAYA KEC BUAI RAWAN

67418413 OKU TIMUR PER/20/042015 RS.TRAUMA CENTRE

13/04/2015 12/04/2016

42 1500000001074 RSUD MUARA RUPIT JL KESEHATAN NO 1 DESA LAWANG AGUNG KEC RUPIT MUSI RAWAS UTARA PER/36/042016 RS.TRAUMA

CENTRE 17/06/2016 01/04/2017

43 1500000001074 RSUD MUARA RUPITJL KESEHATAN NO 1 DESA LAWANG AGUNG KEC RUPIT MUSI RAWAS UTARA PER/39/052015

RS.TRAUMA CENTRE 25/05/2015 24/05/2016

44 1500000000544 RSUD OKU TIMURJL RAYA BELITANG RASUAN NO 1 DESA TULUS AYU KEC BELITANG MANDAGA RAYA

450319 KAB.OKU TIMUR PER/23/042015 RS.TRAUMA CENTRE

13/04/2015 12/04/2016

45 1500000000640 RSUD PRABUMULIH JL LINGKAR KEL GUNUNG IBUL PRABUMULIH TIMUR

7001085 DR. HJ. RUSMINI, M.KES PER/26/042016 RS.TRAUMA CENTRE

10/03/2016 25/01/2017

46 1500000000640 RSUD PRABUMULIHJL LINGKAR KEL GUNUNG IBUL PRABUMULIH TIMUR 7001085 DR. HJ. RUSMINI, M.KES PER/26/042016

RS.TRAUMA CENTRE 13/04/2015 12/04/2016

47 1500000000692 RSUD SITI AISYAHJL LAPTER SILAMPARI KELURAHAN AIR KUTI 452776 LUBUK LINGGAU PER/17/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

48 1500000000692 RSUD SITI AISYAHJL LAPTER SILAMPARI KELURAHAN AIR KUTI

452776 LUBUK LINGGAU PER/35/042016RS.TRAUMA CENTRE

21/06/2016 01/04/2017

49 1500000000691 RSUD TALANG UBIJL TAMAN SISWA KELURAHAN PASAR BHAYANGKARA, KECAMATAN TALANG UBI

390487 DR SHARLIE ESA KENEDY


15/03/2016 25/01/2017


Periode : 01/01/2015 s/d 31/10/2016


133 / 44607-11-201606:23:31



IKS


50 1500000000691 RSUD TALANG UBIJL TAMAN SISWA KELURAHAN PASAR BHAYANGKARA, KECAMATAN TALANG UBI

390487 DR SHARLIE ESA KENEDY PER/24/042015 RS.TRAUMA

CENTRE 13/04/2015 12/04/2016

51 1500000000856 RSUD TEBING TINGGI JL TEBING BENTENG NO.1 KELURAHAN KUPANG KEC TEBING TINGGI 21047 EMPAT LAWANG PER/34/052015 RS.TRAUMA

CENTRE 18/05/2015 17/05/2016

52 1500000000856 RSUD TEBING TINGGI JL TEBING BENTENG NO.1 KELURAHAN KUPANG KEC TEBING TINGGI

21047 EMPAT LAWANG PER/39/042016 RS.TRAUMA CENTRE

17/06/2016 01/04/2017

KANTOR CABANG : G07- KABUPATEN LAHAT


IKS


1 7-4184124083 RUMAH SAKIT BESEMAH PAGAR ALAM

JL. ADE IRMA NASUTION NO. 03 PAGAR ALAM

31511 DR. HARDIANTO, SP.M PER/17/042016 RS.TRAUMA CENTRE

02/08/2016 31/03/2017

2 7-3637140683 RUMAH SAKIT TNI AD TK/IV 02.07.02 LAHAT

JL.LETJEN HARUN SOHAR NO. 26 LAHAT 31411 DR. TEGUH ISMANTO, SP.AN


10/06/2016 01/04/2017

KANTOR CABANG : G08- KABUPATEN OGAN KOMERING ULU (BATURAJA)


IKS


1 7-3718515213 KLINIK 3F MEDIKA JL PUNCAK II NO 748 GUMAWANG BELITANG

32382 DR HJ IDA TRIKANDIANI PER/31/042016 RS.TRAUMA CENTRE

09/06/2016 31/03/2017

2 7-3467565523 RS PANTI BHAKTININGSIH CHARITAS BELITANG

JL CHARITAS NO 1 TEGALREJO BELITANG KAB OKU TIMUR

32382 DR YANTOTASLIM PER/23/042016 RS.TRAUMA CENTRE

20/05/2016 31/03/2017


Periode : 01/01/2015 s/d 31/10/2016


134 / 44607-11-201606:23:31



IKS


3 7-3445151933 RS RUMKIT TK IV DR NOESMIR JL DR M HATTA NO 64 BATURAJA, OKU 32111

DR ELY SAKTI PANAGIAN SIHOTANG, SP B


4 7-3707413963 RSUD IBNU SUTOWO JL DR M HATTA NO 1 BATURAJA TIMUR 32111 DR RYNNA DYANA R PER/21/042016 RS.TRAUMA CENTRE 08/06/2016 31/03/2017

5 7-3463824063 RSUD MARTAPURA JL LETNAN MUCHTAR NO 185 TEBAT SARI, KEC MARTAPURA KAB OKU TIMUR

32311 DR SYLVIA ADHIANI PER/20/042016 RS.TRAUMA CENTRE

19/05/2016 31/03/2017

6 7-3841181693 RSUD MUARA DUA JL RAYA RANAU DESA SUKAJAYA KEC BUAY RAWAN

32211 DR MERI ASTUTI PER/24/042016 RS.TRAUMA CENTRE

17/06/2016 31/03/2017

7 7-3463089453 RSUD OKU TIMURJALAN RAYA BELITANG RASUAN NO 1 TULUS AYU KEC. BELITANG MADANG RAYA KAB OKU TIMUR

32362 3226556518 DR SUGIHARTONO, M. SC PER/25/042016 RS.TRAUMA

CENTRE 19/05/2016 31/03/2017

8 7-3510336383RUMAH SAKIT SANTO ANTONIO JL KOMISARIS UMAR NO 33 BATURAJA 32111

DR ANDREAS HENDRA HIDAYAT PER/22/042016

RS.TRAUMA CENTRE 25/05/2016 24/03/2017

KANTOR CABANG : H00- KANTOR CABANG BANDAR LAMPUNG


IKS


1 1400000000274 BP DARAPETAKJL. RAYA BRANTI DESA BUMI SARI KEC. NATAR

08217711463 DR ELVIRA IRIANTY PER/15/042015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

2 1400000000274 BP DARAPETAKJL. RAYA BRANTI DESA BUMI SARI KEC. NATAR

08217711463

DR ELVIRA IRIANTY PER/15/042016RS.TRAUMA CENTRE

15/08/2016 30/04/2017

3 1400000000113 KLINIK KEDATON MEDICAL CENTER

JL. ZAINAL ABIDIN PAGAR ALAM NO 77/79 GEDUNG MENENG

089623631169

DR. ERVAN BUDIAWAN PER/13/042015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


135 / 44607-11-201606:23:31



IKS


4 1400000000113 KLINIK KEDATON MEDICAL CENTER

JL. ZAINAL ABIDIN PAGAR ALAM NO 77/79 GEDUNG MENENG

089623631169 DR. ERVAN BUDIAWAN PER/13/042016 RS.TRAUMA

CENTRE 25/10/2016 30/04/2017

5 1400000000115 KLINIK KELUARGA PANJANG MEDIKA

JALAN TELUK AMBON NO 14 KEL. PIDADA PANJANG

081279111659 DR AILA KARYUS PER/16/042015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

6 1400000000115 KLINIK KELUARGA PANJANG MEDIKA

JALAN TELUK AMBON NO 14 KEL. PIDADA PANJANG

081279111659

DR AILA KARYUS PER/16/042016 RS.TRAUMA CENTRE

09/06/2016 30/04/2017

7 1400000000503 KLINIK KOSASIH AMANAH JL. IKAN KEMBUNG NO. 70 A TELUK BETUNG BANDAR LAMPUNG

35223 7175938 DR.S.TRI.HERLIANTO,SH,MH,MM,MKES


04/01/2016 30/11/2016

8 1400000000500 KLINIK KOSASIH KEMILING JL. TEUKU CIK DITIRO BLOK E NO. 4 KEMILING BANDAR LAMPUNG 35158 3540424 DR.S.TRI.HERLIANTO,SH,

MH,MM,MKES PER/22/112015 RS.TRAUMA CENTRE 04/01/2016 30/11/2016

9 1400000000504 KLINIK KOSASIH PALAPAJL. CUT NYAK DIEN NO. 62 PALAPA BANDAR LAMPUNG 35116 7140218

DR.S.TRI.HERLIANTO,SH,MH,MM,MKES PER/26/112015

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

10 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

11 1400000000498 KLINIK KOSASIH SUMBER WARAS

JL. RAYA GADING REJO NO. 221 GADING REJO



04/01/2016 30/11/2016

12 1400000000508KLINIK KOSASIH TANJUNGAN

JL. LINTAS SUMATERA SIMPANG KATES TANJUNG AGUNG LAMPUNG SELATAN 7773665


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

13 1400000000501 KLINIK KOSASIH TELUKJL. IKAN SALEM NO. 05 TELUK BETUNG BANDAR LAMPUNG 7641529


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

14 1400000000502KLINIK KOSASIH TIRTAYASA

JL. PANGERAN TIRTAYASA NO. 181 SUKABUMI BANDAR LAMPUNG

7167635DR.S.TRI.HERLIANTO,SH,MH,MM,MKES


04/01/2016 30/11/2016

15 1400000000114 KLINIK LEMATANG MEDICAL CENTER

JL. SUTAMI KM. 11 NO. 135 LEMATANG TANJUNG BINTANG

0721350145

DR AGUS KELANA BENNIKURNIAWAN


01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


136 / 44607-11-201606:23:31



IKS


16 1400000000114 KLINIK LEMATANG MEDICAL CENTER

JL. SUTAMI KM. 11 NO. 135 LEMATANG TANJUNG BINTANG

0721350145

DR AGUS KELANA BENNIKURNIAWAN PER/14/042016 RS.TRAUMA

CENTRE 01/06/2016 30/04/2017

17 1400000000499 KLINIK MITRA KOSASIH JL. MS. BATUBARA NO. 70 KUPANG TEBA TELUK BETUNG BANDAR LAMPUNG 7327768 DR.S.TRI.HERLIANTO,SH,


18 1400000000497 KLINIK RAWAT INAP KOSASIH RAJABASA

JL. KAPTEN ABDUL HAQ NO 9/31 RAJABASA 7511491 DR.S.TRI.HERLIANTO,SH,MH,MM,MKES


04/01/2016 30/11/2016

19 1400000000505 KLINIK RAWAT INAP KOSASIH TUGU

JL. KAPTEN HAYAM WURUK NO. 20 TANJUNG KARANG TIMUR



04/01/2016 30/11/2016

20 1400000000496 KLINIK RAWAT INAP KOSASIH URIP JL URIP SUMOHARJO NO 176 KEDATON 3526413 DR.S.TRI.HERLIANTO,SH,


21 1500000000181RS 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

22 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


01/02/2015 31/01/2016

23 1500000000700 RS IMANUEL WAY HALIM JL. SOEKARNO HATTA KEL. WAY DADI KEC. SUKARAME

704900 YAYASAN RUMAH SAKITBAPTIS INDONESIA


01/05/2015 30/04/2016

24 1500000000700 RS IMANUEL WAY HALIMJL. SOEKARNO HATTA KEL. WAY DADI KEC. SUKARAME 704900

YAYASAN RUMAH SAKITBAPTIS INDONESIA PER/12/042016

RS.TRAUMA CENTRE 25/05/2016 30/04/2017

25 1500000000401 RS MITRA HUSADA JL. JEND. A. YANI NO. 14 PRINGSEWU 23792PT MITRA HUSADA BERSAMA PER/10/032016

RS.TRAUMA CENTRE 09/06/2016 31/03/2017

26 1500000000401 RS MITRA HUSADA JL. JEND. A. YANI NO. 14 PRINGSEWU 23792PT MITRA HUSADA BERSAMA


01/04/2015 31/03/2016

27 1500000000253 RS MUHAMMADIYAH METRO

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

7008000 PERSYARIKATAN MUHAMMADIYAH


01/03/2015 29/02/2016


Periode : 01/01/2015 s/d 31/10/2016


137 / 44607-11-201606:23:31



IKS


28 1500000000253 RS MUHAMMADIYAH METRO

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

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

29 1500000000209 RS NATAR MEDIKA JL. RAYA NATAR NOMOR 4 MUARA PUTIH 92521 YAYASAN ABDI KARYA PER/07/012015 RS.TRAUMA CENTRE 01/02/2015 31/01/2016

30 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

31 1500000000218 RS TINGKAT IV 02.07.04 (RS DKT) BANDAR LAMPUNG

JL. KAPT. A RIVAI 7 PENENGAHAN TANJUNG KARANG PUSAT


01/03/2015 29/02/2016

32 1500000000218 RS TINGKAT IV 02.07.04 (RS DKT) BANDAR LAMPUNG

JL. KAPT. A RIVAI 7 PENENGAHAN TANJUNG KARANG PUSAT 770430 PER/08/022016 RS.TRAUMA

CENTRE 28/03/2016 28/02/2017

33 1400000000116 RS URIP SUMOHARJO JL URIP SUMOHARJO NO 200 SUKARAME 771322PT GUNUNG SULAH MEDIKA PER/07/022016

RS.TRAUMA CENTRE 16/03/2016 28/02/2017

34 1400000000116 RS URIP SUMOHARJO JL URIP SUMOHARJO NO 200 SUKARAME 771322 PT GUNUNG SULAH MEDIKA


01/03/2015 29/02/2016

35 1500000000115 RS WISMA RINI JL. WISMA RINI NO. 01 PRINGSEWU 21582 YAYASAN BUDI SETIA BHAKTI


10/02/2016 31/01/2017

36 1500000000115 RS WISMA RINI JL. WISMA RINI NO. 01 PRINGSEWU 21582YAYASAN BUDI SETIA BHAKTI PER/01/012015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

37 1500000000165RSUD DR. H. ABDUL MOELOEK PROVINSI LAMPUNG

JALAN DR. RIVAI NOMOR 06 PENENGAHAN 703312 PROVINSI LAMPUNG PER/05/012015RS.TRAUMA CENTRE 10/02/2016 31/01/2017

38 1500000000165RSUD DR. H. ABDUL MOELOEK PROVINSI LAMPUNG

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

01/02/2015 31/01/2016

39 1400000000471 RSUD DR. H. BOB BAZAR, SKM

JALAN LETTU ROHANI NOMOR 14B KALIANDA


04/01/2016 30/11/2016


Periode : 01/01/2015 s/d 31/10/2016


138 / 44607-11-201606:23:31



IKS


40 1500000000134 RSUD PESAWARAN JL. RAYA KEDONDONG DESA WAY LAYAP KEC. GEDONG TATAAN

KABUPATEN PESAWARAN PER/03/012015 RS.TRAUMA

CENTRE 01/02/2015 31/01/2016

41 1500000000134 RSUD PESAWARAN JL. RAYA KEDONDONG DESA WAY LAYAP KEC. GEDONG TATAAN

KABUPATEN PESAWARAN PER/02/022016 RS.TRAUMA

CENTRE 16/02/2016 31/01/2017

42 1500000000427 UPTD BALAI LATIHAN KERJA BANDAR LAMPUNG

JL. PAGAR ALAM NOMOR 127 BANDAR LAMPUNG

DINAS TENAGA KERJA DAN TRANSMIGRASI PROVINSI LAMPUNG


01/03/2015 29/02/2016

43 1500000000427 UPTD BALAI LATIHAN KERJA BANDAR LAMPUNG

JL. PAGAR ALAM NOMOR 127 BANDAR LAMPUNG

DINAS TENAGA KERJA DAN TRANSMIGRASI PROVINSI LAMPUNG


28/03/2016 28/02/2017

KANTOR CABANG : H01- KANTOR CABANG LAMPUNG TENGAH


IKS


1 1500000000710 BP. ALAYA MEDIKA JALAN JENDRAL SUDIRMAN NO. 407 KOTABUMI

DR. HJ. MAYA METISSA PER/009/042015 RS.TRAUMA CENTRE

24/04/2015 23/04/2016

2 7-2738805337KLINIK PRATAMA RAWAT INAP PT. GREAT GIANT PINEAPPLE

KAMPUNG TERBANGGI BESAR KM 77 KEC. TERBANGGI BESAR 34163

PT. GREAT GIANT PINEAPPLE PER/001/012016

RS.TRAUMA CENTRE 06/04/2016 19/01/2017

3 1500000001188PUSKESMAS BANDAR AGUNG BANDAR AGUNG, KEC. TERUSAN NUNYAI DR. LINDAWATY PER/004/02016

RS.TRAUMA CENTRE 29/07/2016 29/05/2018

4 1500000001188PUSKESMAS BANDAR AGUNG

BANDAR AGUNG, KEC. TERUSAN NUNYAI DR. LINDAWATYPER / 012 / 052015

RS.TRAUMA CENTRE

29/05/2015 28/05/2016

5 1500000001192 PUSKESMAS BANDAR JAYA JL. A.YANI NO.33 BANDAR JAYA, KEC. TERBANGGI BESAR

DR. LINDAWATY PER/08/052016 RS.TRAUMA CENTRE

29/07/2016 29/05/2018


Periode : 01/01/2015 s/d 31/10/2016


139 / 44607-11-201606:23:31



IKS


6 1500000001192 PUSKESMAS BANDAR JAYA JL. A.YANI NO.33 BANDAR JAYA, KEC. TERBANGGI BESAR DR. LINDAWATY PER / 012 /

052015RS.TRAUMA CENTRE 29/05/2015 28/05/2016

7 1500000001168 PUSKESMAS BANGUNREJO DS. BANGUNREJO, KEC. BANGUNREJO DR. LINDAWATY PER/08/2016 RS.TRAUMA CENTRE 29/07/2016 29/05/2018

8 1500000001168 PUSKESMAS BANGUNREJO DS. BANGUNREJO, KEC. BANGUNREJO DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE

29/05/2015 28/05/2016

9 1500000001181 PUSKESMAS BINA KARYA UTAMA

BUMI NABUNG, KEC. BUMI NABUNG DR. LINDAWATY PER/08/252016 RS.TRAUMA CENTRE

29/07/2016 29/05/2018

10 1500000001181 PUSKESMAS BINA KARYA UTAMA BUMI NABUNG, KEC. BUMI NABUNG DR. LINDAWATY PER / 012 /

052015RS.TRAUMA CENTRE 29/05/2015 28/05/2016

11 1500000001182 PUSKESMAS BUMI NABUNG BUMI NABUNG, KEC. BUMI NABUNG DR. LINDAWATYPER / 012 / 052015

RS.TRAUMA CENTRE 29/05/2015 28/05/2016

12 1500000001182 PUSKESMAS BUMI NABUNG BUMI NABUNG, KEC. BUMI NABUNG DR. LINDAWATY PER/08/2016 RS.TRAUMA CENTRE

29/07/2016 29/05/2018

13 1500000001189 PUSKESMAS CANDI REJO JL. RAYA LINTAS SUMATERA, KEC. WAY PANGUBUAN


29/07/2016 29/05/2018

14 1500000001189 PUSKESMAS CANDI REJOJL. RAYA LINTAS SUMATERA, KEC. WAY PANGUBUAN DR. LINDAWATY

PER / 012 / 052015

RS.TRAUMA CENTRE 29/05/2015 28/05/2016

15 1500000001179PUSKESMAS GAYA BARU LIMA GAYA BARU V, KEC. BANDAR SURABAYA DR. LINDAWATY

PER / 012 / 052015

RS.TRAUMA CENTRE 29/05/2015 28/05/2016

16 1500000001179PUSKESMAS GAYA BARU LIMA

GAYA BARU V, KEC. BANDAR SURABAYA DR. LINDAWATY PER/08/2016RS.TRAUMA CENTRE

29/07/2016 29/06/2018

17 1500000001164 PUSKESMAS GEDUNG SARI GEDUNG SARI, KEC. ANAK RATU AJI DR. LINDAWATY PER/08/2016 RS.TRAUMA CENTRE

29/07/2016 29/05/2018


Periode : 01/01/2015 s/d 31/10/2016


140 / 44607-11-201606:23:31



IKS


18 1500000001164 PUSKESMAS GEDUNG SARI GEDUNG SARI, KEC. ANAK RATU AJI DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE 29/05/2015 28/05/2016

19 1500000001171 PUSKESMAS GUNUNG SUGIH DS. GUNUNG SUGIH, KEC. GUNUNG SUGIH DR. LINDAWATY PER / 012 /

052015RS.TRAUMA CENTRE 29/05/2015 28/05/2016

20 1500000001171 PUSKESMAS GUNUNG SUGIH

DS. GUNUNG SUGIH, KEC. GUNUNG SUGIH DR. LINDAWATY PER/08/052016 RS.TRAUMA CENTRE

29/07/2016 29/05/2018

21 1500000001163 PUSKESMAS HAJI PEMANGGILAN

DS. HAJI PEMANGGILAN, KEC. ANAK TUHA DR. LINDAWATY PER/08/2016 RS.TRAUMA CENTRE

29/07/2016 29/05/2018

22 1500000001163 PUSKESMAS HAJI PEMANGGILAN DS. HAJI PEMANGGILAN, KEC. ANAK TUHA DR. LINDAWATY PER / 012 /

052015RS.TRAUMA CENTRE 29/05/2015 28/05/2016

23 1500000001186 PUSKESMAS JATI DATAR JATI DATAR, KEC. BANDAR MATARAM DR. LINDAWATY PER/08-2016RS.TRAUMA CENTRE 29/07/2016 29/05/2018

24 1500000001186 PUSKESMAS JATI DATAR JATI DATAR, KEC. BANDAR MATARAM DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE

29/05/2015 28/05/2016

25 1500000001165 PUSKESMAS KALIREJO KALIREJO, KEC. KALIREJO DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE

29/05/2015 28/05/2016

26 1500000001165 PUSKESMAS KALIREJO KALIREJO, KEC. KALIREJO DR. LINDAWATY PER/08/052016RS.TRAUMA CENTRE 29/07/2016 28/05/2018

27 1500000001156PUSKESMAS KARANG ANYAR

DS. KARANG ANYAR, KEC. SELAGAI LINGGA DR. LINDAWATY PER/08/052016

RS.TRAUMA CENTRE 29/07/2016 29/05/2018

28 1500000001156PUSKESMAS KARANG ANYAR

DS. KARANG ANYAR, KEC. SELAGAI LINGGA

DR. LINDAWATYPER / 012 / 052015

RS.TRAUMA CENTRE

29/05/2015 28/05/2016

29 1500000001173 PUSKESMAS KESUMADADI DS. KASUMADADI, KEC. BEKRI DR. LINDAWATY PER/08/2016 RS.TRAUMA CENTRE

29/07/2016 29/05/2018


Periode : 01/01/2015 s/d 31/10/2016


141 / 44607-11-201606:23:31



IKS


30 1500000001173 PUSKESMAS KESUMADADI DS. KASUMADADI, KEC. BEKRI DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE 29/05/2015 28/05/2016

31 1500000001196 PUSKESMAS KOTA GAJAH JL. RAYA GUNUNG SUGIH, KEC. KOTA GAJAH DR. LINDAWATY PER/08/2016 RS.TRAUMA

CENTRE 29/07/2016 29/05/2018

32 1500000001196 PUSKESMAS KOTA GAJAH JL. RAYA GUNUNG SUGIH, KEC. KOTA GAJAH

DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE

29/05/2015 28/05/2016

33 1500000001118 PUSKESMAS PADANG RATU HAYUNGAN RATU, KEC. PADANG RATU DR. LINDAWATY PER/08/052015 RS.TRAUMA CENTRE

29/07/2016 29/05/2018

34 1500000001118 PUSKESMAS PADANG RATU HAYUNGAN RATU, KEC. PADANG RATU DR. LINDAWATY PER/012/052015 RS.TRAUMA CENTRE 29/05/2015 28/04/2016

35 1500000001157 PUSKESMAS PAYUNG REJO DS. PAYUNGREJO, KEC. PUBIAN DR. LINDAWATYPER / 012 / 052015

RS.TRAUMA CENTRE 29/05/2015 28/05/2016

36 1500000001157 PUSKESMAS PAYUNG REJO DS. PAYUNGREJO, KEC. PUBIAN DR. LINDAWATY PER/08/052016 RS.TRAUMA CENTRE

29/07/2016 29/05/2018

37 1500000001166 PUSKESMAS PONCOWARNO DS. PONCOWARNO, KEC. KALIREJO DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE

29/05/2015 28/05/2016

38 1500000001166 PUSKESMAS PONCOWARNO DS. PONCOWARNO, KEC. KALIREJO DR. LINDAWATY PER/08/052016RS.TRAUMA CENTRE 29/07/2016 29/05/2018

39 1500000001191 PUSKESMAS PONCOWATIJL. A.YANI NO.1 PONCOWATI, KEC. TERBANGGI BESAR DR. LINDAWATY PER/08/052016

RS.TRAUMA CENTRE 29/07/2016 29/05/2018

40 1500000001191 PUSKESMAS PONCOWATIJL. A.YANI NO.1 PONCOWATI, KEC. TERBANGGI BESAR


RS.TRAUMA CENTRE

29/05/2015 28/05/2016

41 1500000001198 PUSKESMAS PUJO KERTO JL. RAYA GOTONG ROYONG, KEC. TRIMURJO


RS.TRAUMA CENTRE

29/05/2015 28/05/2016


Periode : 01/01/2015 s/d 31/10/2016


142 / 44607-11-201606:23:31



IKS


42 1500000001198 PUSKESMAS PUJO KERTO JL. RAYA GOTONG ROYONG, KEC. TRIMURJO DR. LINDAWATY PER/08/052016 RS.TRAUMA

CENTRE 28/05/2016 29/05/2018

43 1500000001197 PUSKESMAS PUNGGUR TANGGULANGIN, KEC. PUNGGUR DR. LINDAWATY PER/08/052016 RS.TRAUMA CENTRE 29/07/2016 29/05/2018

44 1500000001197 PUSKESMAS PUNGGUR TANGGULANGIN, KEC. PUNGGUR DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE

29/05/2015 28/05/2016

45 1500000001193 PUSKESMAS RAMA INDRA RAMA INDRA, KEC. SEPUTIH RAMAN DR. LINDAWATY PER/08/05-2016 RS.TRAUMA CENTRE

29/07/2016 29/05/2018

46 1500000001193 PUSKESMAS RAMA INDRA RAMA INDRA, KEC. SEPUTIH RAMAN DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE 29/05/2015 28/05/2016

47 1500000001183 PUSKESMAS RUMBIA RESTU BARU, KEC. RUMBIA DR. LINDAWATY PER/08/052016RS.TRAUMA CENTRE 29/07/2016 29/05/2018

48 1500000001183 PUSKESMAS RUMBIA RESTU BARU, KEC. RUMBIA DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE

29/05/2015 28/05/2016

49 1500000001162 PUSKESMAS SEGALA MIDER JL PRAMUKA KAMPUNG SEGALA MIDER KEC PUBIAN


RS.TRAUMA CENTRE

29/05/2015 28/05/2016

50 1500000001162 PUSKESMAS SEGALA MIDERJL PRAMUKA KAMPUNG SEGALA MIDER KEC PUBIAN DR. LINDAWATY PER/08/052016

RS.TRAUMA CENTRE 29/07/2016 29/05/2018

51 1500000001167PUSKESMAS SENDANG AGUNG

DS. SENDANG AGUNG, KEC. SENDANG AGUNG DR. LINDAWATY

PER / 012 / 052015

RS.TRAUMA CENTRE 29/05/2015 28/05/2016

52 1500000001167PUSKESMAS SENDANG AGUNG

DS. SENDANG AGUNG, KEC. SENDANG AGUNG

DR. LINDAWATY PER/08/052016RS.TRAUMA CENTRE

29/07/2016 29/05/2018

53 1500000001185 PUSKESMAS SEPUTIH BANYAK

DS. SEPUTIH BANYAK, KEC. SEPUTIH BANYAK


RS.TRAUMA CENTRE

29/05/2015 28/05/2016


Periode : 01/01/2015 s/d 31/10/2016


143 / 44607-11-201606:23:31



IKS


54 1500000001185 PUSKESMAS SEPUTIH BANYAK

DS. SEPUTIH BANYAK, KEC. SEPUTIH BANYAK DR. LINDAWATY PER/08/052016 RS.TRAUMA

CENTRE 29/07/2016 29/05/2018

55 1500000001187 PUSKESMAS SEPUTIH MATARAM REJOSARI, KEC. SEPUTIH MATARAM DR. LINDAWATY PER / 012 /

052015RS.TRAUMA CENTRE 29/05/2015 28/05/2016

56 1500000001187 PUSKESMAS SEPUTIH MATARAM

REJOSARI, KEC. SEPUTIH MATARAM DR. LINDAWATY PER/08/052016 RS.TRAUMA CENTRE

29/07/2016 29/05/2018

57 1500000001194 PUSKESMAS SEPUTIH RAMAN

JL. RAYA SEPUTIH RAMAN, KEC. SEPUTIH RAMAN


RS.TRAUMA CENTRE

29/05/2015 28/05/2016

58 1500000001194 PUSKESMAS SEPUTIH RAMAN

JL. RAYA SEPUTIH RAMAN, KEC. SEPUTIH RAMAN DR. LINDAWATY PER/08/02016 RS.TRAUMA

CENTRE 29/07/2016 29/05/2018

59 1500000001180PUSKESMAS SEPUTIH SURABAYA

SEPUTIH SURABAYA, KEC. SEPUTIH SURABAYA DR. LINDAWATY

PER / 012 / 052015

RS.TRAUMA CENTRE 29/05/2015 28/05/2016

60 1500000001180 PUSKESMAS SEPUTIH SURABAYA

SEPUTIH SURABAYA, KEC. SEPUTIH SURABAYA


29/07/2016 29/05/2018

61 1500000001199 PUSKESMAS SIMBAR WARINGIN

DS. SIMBAR WARINGIN, KEC. TRIMURJO DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE

29/05/2015 28/05/2016

62 1500000001199PUSKESMAS SIMBAR WARINGIN DS. SIMBAR WARINGIN, KEC. TRIMURJO DR. LINDAWATY PER/08/05-2016

RS.TRAUMA CENTRE 29/07/2016 29/05/2018

63 1500000001190PUSKESMAS SIMPANG AGUNG

DS. SIMPANG AGUNG, KEC. SEPUTIH AGUNG DR. LINDAWATY PER/08/052016

RS.TRAUMA CENTRE 29/07/2016 29/05/2018

64 1500000001190PUSKESMAS SIMPANG AGUNG

DS. SIMPANG AGUNG, KEC. SEPUTIH AGUNG


RS.TRAUMA CENTRE

29/05/2015 28/05/2016

65 1500000001195 PUSKESMAS SRI TEJO KENCONO

SRITEJO KENCONO, KEC. KOTA GAJAH DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE

29/05/2015 28/05/2016


Periode : 01/01/2015 s/d 31/10/2016


144 / 44607-11-201606:23:31



IKS


66 1500000001195 PUSKESMAS SRI TEJO KENCONO SRITEJO KENCONO, KEC. KOTA GAJAH DR. LINDAWATY PER/08/052016 RS.TRAUMA

CENTRE 29/07/2016 29/05/2018

67 1500000001176 PUSKESMAS SRI WIJAYA MATARAM JATI DATAR, KEC. BANDAR MATARAM DR. LINDAWATY PER/08/052016 RS.TRAUMA

CENTRE 29/07/2016 29/05/2018

68 1500000001176 PUSKESMAS SRI WIJAYA MATARAM

JATI DATAR, KEC. BANDAR MATARAM DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE

29/05/2015 28/05/2016

69 1500000001170 PUSKESMAS SUKA NEGARA SUKA NEGARA, KEC. BANGUNREJO DR. LINDAWATY PER/08/052016 RS.TRAUMA CENTRE

29/07/2016 29/05/2018

70 1500000001170 PUSKESMAS SUKA NEGARA SUKA NEGARA, KEC. BANGUNREJO DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE 29/05/2015 28/05/2016

71 1500000001184PUSKESMAS SUKO BINANGUN JL. MERDEKA NO.1, KEC. WAY SEPUTIH DR. LINDAWATY per/08/052016

RS.TRAUMA CENTRE 29/07/2016 29/05/2018

72 1500000001184 PUSKESMAS SUKO BINANGUN

JL. MERDEKA NO.1, KEC. WAY SEPUTIH DR. LINDAWATY PER / 012 / 052015

RS.TRAUMA CENTRE

29/05/2015 28/05/2016

73 1500000001155 PUSKESMAS SURABAYA DS. SURABAYA, KEC. PADANG RATU DR. LINDAWATY PER/08/052016 RS.TRAUMA CENTRE

29/07/2016 29/05/2018

74 1500000001155 PUSKESMAS SURABAYA DS. SURABAYA, KEC. PADANG RATU DR. LINDAWATYPER / 012 / 052015

RS.TRAUMA CENTRE 29/05/2015 28/05/2016

75 1500000001172PUSKESMAS TERBANGGI SUBING

JL. LINTAS SUMATERA,TERBANGGI SUBING, KEC. GUNUNG SUGIH DR. LINDAWATY

PER / 012 / 052015

RS.TRAUMA CENTRE 29/05/2015 28/05/2016

76 1500000001172PUSKESMAS TERBANGGI SUBING

JL. LINTAS SUMATERA,TERBANGGI SUBING, KEC. GUNUNG SUGIH

DR. LINDAWATY PER/08/052016RS.TRAUMA CENTRE

29/07/2016 29/05/2018

77 1500000001200 PUSKESMAS WATES JL. RAYA LINTAS SUMATERA, KEC. BUMI RATU NUBAN


29/07/2016 29/05/2018


Periode : 01/01/2015 s/d 31/10/2016


145 / 44607-11-201606:23:31



IKS


78 1500000001200 PUSKESMAS WATES JL. RAYA LINTAS SUMATERA, KEC. BUMI RATU NUBAN DR. LINDAWATY PER / 012 /

052015RS.TRAUMA CENTRE 29/05/2015 28/05/2016

79 1500000000357 RS BLK METRO JALAN DEWI SARTIKA NO. 90 BANJAR SARI METRO UTARA TRI RETNO PALUPI, SH PER/005/032015 RS.TRAUMA

CENTRE 05/03/2015 04/03/2016

80 1500000000357 RS BLK METRO JALAN DEWI SARTIKA NO. 90 BANJAR SARI METRO UTARA

TRI RETNO PALUPI, SH PER/021/092016 RS.TRAUMA CENTRE

15/09/2016 14/09/2018

81 1500000000651 RS BLK WAY ABUNG JALAN TATA KARYA WAY ABUNG I SUNARTO, SE PER/010/042015 RS.TRAUMA CENTRE

27/04/2015 26/04/2016

82 1500000000319 RS HARAPAN BUNDA JL. LINTAS SUMATERA NO. 30 SEPUTIH JAYA, GUNUNG SUGIH 26766 DR. WIDYA SISTHA

PRIMA, MARS PER/11/062016 RS.TRAUMA CENTRE 21/06/2016 11/04/2018

83 1500000000319 RS HARAPAN BUNDAJL. LINTAS SUMATERA NO. 30 SEPUTIH JAYA, GUNUNG SUGIH 26766

DR. WIDYA SISTHA PRIMA, MARS PER/007/032015

RS.TRAUMA CENTRE 01/03/2015 29/02/2016

84 1500000000318 RS ISLAM ASY-SYIFAA JL. LINTAS SUMATRA KM 65 BANDAR JAYA 34163 DR. JOSI HARNOS PER/004/032016 RS.TRAUMA CENTRE

07/03/2016 01/03/2017

85 1500000000318 RS ISLAM ASY-SYIFAA JL. LINTAS SUMATRA KM 65 BANDAR JAYA 34163 DR. JOSI HARNOS PER/006/032015 RS.TRAUMA CENTRE

01/03/2015 29/02/2016

86 7-1568007187RS YUKUM MEDICAL CENTRE

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

PT. MITRA MEDICAL CENTER PER/002/012016

RS.TRAUMA CENTRE 22/02/2016 31/01/2017

87 1400000000202RSD MAYJEN. HM. RYACUDU

JL. JENDERAL SUDIRMAN NO. 2 KEC. KOTABUMI SELATAN DR. HJ. MAYA METISSA PER/13/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

88 1400000000202RSD MAYJEN. HM. RYACUDU

JL. JENDERAL SUDIRMAN NO. 2 KEC. KOTABUMI SELATAN

DR. HJ. MAYA METISSA PER/05-2016RS.TRAUMA CENTRE

02/06/2016 02/06/2017

89 1500000000450 RSU HANDAYANI JL. SOEKARNO HATTA NO. 94 TANJUNG HARAPAN KEC. KOTABUMI SELATAN

328399 DR. H. DJAUHARI THALIB, M.KES


30/03/2015 29/03/2016


Periode : 01/01/2015 s/d 31/10/2016


146 / 44607-11-201606:23:31



IKS


90 1500000000450 RSU HANDAYANI JL. SOEKARNO HATTA NO. 94 TANJUNG HARAPAN KEC. KOTABUMI SELATAN 328399 DR. H. DJAUHARI

THALIB, M.KES PER/19/052016 RS.TRAUMA CENTRE 21/06/2016 27/05/2017

91 1400000000185 RSUD DEMANG SEPULAU RAYA

JALAN RAYA LINTAS SUMATERA KAMPUNG TERBANGGI AGUNG KEC. GUNUNG SUGIH

529898 DRG. ISMUDIJANTO PER/10/062016 RS.TRAUMA CENTRE 01/06/2016 30/06/2017

92 1400000000185 RSUD DEMANG SEPULAU RAYA

JALAN RAYA LINTAS SUMATERA KAMPUNG TERBANGGI AGUNG KEC. GUNUNG SUGIH

529898 DRG. ISMUDIJANTO PER/014/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

93 1400000000308 RSUD MENGGALA JL. MEGOW PAK NO. 08 MENGGALA 21131 DR. FEBY LEVARINA, SP.PK, M.KES


01/06/2015 31/05/2016

KANTOR CABANG : J00- KANTOR CABANG JAKARTA SALEMBA


IKS


1 1500000001278 KLINIK PERTAMEDIKA JL. PERWIRA NO.2-4 KEL. GAMBIR KEC. GAMBIR JAKARTA PUSAT

DR NENY HERAWATI PER/84/042016 RS.TRAUMA CENTRE

13/05/2016 31/03/2017

2 1500000001278 KLINIK PERTAMEDIKAJL. PERWIRA NO.2-4 KEL. GAMBIR KEC. GAMBIR JAKARTA PUSAT DR NENY HERAWATI PER/28/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

3 1500000001784 KLINIK PERTAMEDIKA DELI JL AHMAD YANI NO 2, KEL UTAN KAYU 10110 PER/118/072016RS.TRAUMA CENTRE 20/07/2016 30/06/2017

4 1500000001784 KLINIK PERTAMEDIKA DELI JL AHMAD YANI NO 2, KEL UTAN KAYU 10110 PER/47/072015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

5 1500000001785 KLINIK PERTAMEDIKA MEDAN SATRIA

KOMPLEKS PERTAMINA MEDAN SATRIA, JLARUN IX NO 2


01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


147 / 44607-11-201606:23:31



IKS


6 1500000001785 KLINIK PERTAMEDIKA MEDAN SATRIA

KOMPLEKS PERTAMINA MEDAN SATRIA, JLARUN IX NO 2 13110 PER/118/072016 RS.TRAUMA

CENTRE 20/07/2016 30/06/2017

7 1500000001787KLINIK PERTAMEDIKA MEDICAL CENTRE SINABUNG

JL SINABUNG II NO 32 F 12110 PER/47/072015 RS.TRAUMA CENTRE 01/07/2015 30/06/2016

8 1500000001787KLINIK PERTAMEDIKA MEDICAL CENTRE SINABUNG

JL SINABUNG II NO 32 F 12110 PER/118/072016 RS.TRAUMA CENTRE

20/07/2016 30/06/2017

9 1500000001789 KLINIK PERTAMEDIKA MERDEKA TIMUR

JL MERDEKA TIMUR NO 12 JAKARTA PUSAT


01/07/2015 30/06/2016

10 1500000001788 KLINIK PERTAMEDIKA PATRA JASA

GD PATRA LT 1 RUANG 1E JL JEND GATOT SUBROTO KAV 32-34 12110 PER/118/072016 RS.TRAUMA

CENTRE 20/07/2016 30/06/2017

11 1500000001788KLINIK PERTAMEDIKA PATRA JASA

GD PATRA LT 1 RUANG 1E JL JEND GATOT SUBROTO KAV 32-34 12110 PER/47/072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

12 1500000001786 KLINIK PERTAMEDIKA RAWAMANGUN

JL MUNDU RAYA NO 1 RT/RW 12/04 PULO GADUNG


20/07/2016 30/06/2017

13 1500000001786 KLINIK PERTAMEDIKA RAWAMANGUN

JL MUNDU RAYA NO 1 RT/RW 12/04 PULO GADUNG


01/07/2015 30/06/2016

14 1500000001790KLINIK PERTAMEDIKA TUGU

JL HR RASUNA SAID KAV 8-9, KARET , SETIABUDI 12120 PER/47/072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

15 1500000001783KLINIK PERTAMEDIKA YOS SUDARSO JL YOS SUDARSO NO 34 ,TANJUNG PRIOK 14110 PER/118/072016

RS.TRAUMA CENTRE 20/07/2016 30/06/2017

16 1500000001783KLINIK PERTAMEDIKA YOS SUDARSO

JL YOS SUDARSO NO 34 ,TANJUNG PRIOK 14110 PER/47/072015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

17 1400000000304 KLINIK SUMBER SEHAT JL. PERCETAKAN NEGARA 2 BLOK J NO. 14-15, KELURAHAN JOHAR BARU

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

28/03/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


148 / 44607-11-201606:23:31



IKS


18 1400000000304 KLINIK SUMBER SEHAT JL. PERCETAKAN NEGARA 2 BLOK J NO. 14-15, KELURAHAN JOHAR BARU 4240700 DR EDI SETIAWAN PER/53/082015 RS.TRAUMA

CENTRE 01/09/2015 31/12/2015

19 1500000000951 PUSAT PELATIHAN KERJA DAERAH JAKARTA PUSAT

JALAN KARET PASAR BARU V NO 23 BENDUNGAN HILIR JAKARTA PUSAT PER/30/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

20 1500000000951 PUSAT PELATIHAN KERJA DAERAH JAKARTA PUSAT

JALAN KARET PASAR BARU V NO 23 BENDUNGAN HILIR JAKARTA PUSAT

PER/106052016 RS.TRAUMA CENTRE

24/06/2016 30/04/2017

21 1500000000993 PUSKESMAS KECAMATAN CEMPAKA PUTIH

JL CEMPAKA PUTIH BARAT XIX NO 2 RT 07/07


14/06/2016 31/05/2017

22 1500000000993 PUSKESMAS KECAMATAN CEMPAKA PUTIH

JL CEMPAKA PUTIH BARAT XIX NO 2 RT 07/07 PER/36/062015 RS.TRAUMA

CENTRE 01/01/2015 31/05/2016

23 1500000001821PUSKESMAS KECAMATAN SENEN JL KRAMAT VII NO 31 KEL KENARI 10110 PER/119/072016

RS.TRAUMA CENTRE 15/07/2016 30/06/2017

24 1500000001821 PUSKESMAS KECAMATAN SENEN

JL KRAMAT VII NO 31 KEL KENARI 10110 PER/46/072015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

25 1500000001826 PUSKESMAS KELURAHAN BUNGUR

JL BUNGUR BESAR IX NO 20 RT 014/01 10110 PER/119/072016 RS.TRAUMA CENTRE

15/07/2016 30/06/2017

26 1500000001826PUSKESMAS KELURAHAN BUNGUR JL BUNGUR BESAR IX NO 20 RT 014/01 10110 PER/46/072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

27 1500000001002PUSKESMAS KELURAHAN CEMPAKA PUTIH BARAT II JL CEMPAKA PUTIH BARAT 2D NO 10A PER/36/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

28 1500000001002PUSKESMAS KELURAHAN CEMPAKA PUTIH BARAT II

JL CEMPAKA PUTIH BARAT 2D NO 10A PER/110/062016RS.TRAUMA CENTRE

15/07/2016 31/05/2017

29 1500000001823 PUSKESMAS KELURAHAN KENARI

JL JAMRUD NO 22 RT 008/02 10110 PER/46/072015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


149 / 44607-11-201606:23:31



IKS


30 1500000001823 PUSKESMAS KELURAHAN KENARI JL JAMRUD NO 22 RT 008/02 10110 PER/119/072016 RS.TRAUMA

CENTRE 15/07/2016 30/06/2017

31 1500000001822 PUSKESMAS KELURAHAN KRAMAT JL KRAMAT SENTIONG I/33, RT 010/07 10110 PER/46/072015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

32 1500000001822 PUSKESMAS KELURAHAN KRAMAT

JL KRAMAT SENTIONG I/33, RT 010/07 10110 PER/119/072016 RS.TRAUMA CENTRE

15/07/2016 30/06/2017

33 1500000001825 PUSKESMAS KELURAHAN KWITANG

JL KWITANG RAYA 1 C NO.27 RT 006/04 10110 PER/46/072015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

34 1500000001825 PUSKESMAS KELURAHAN KWITANG JL KWITANG RAYA 1 C NO.27 RT 006/04 10110 PER/119/072016 RS.TRAUMA

CENTRE 15/07/2016 30/06/2017

35 1500000001824PUSKESMAS KELURAHAN PASEBAN JL KRAMAT SAWAH VII NO 7 10110 PER/46/072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

36 1500000001824 PUSKESMAS KELURAHAN PASEBAN

JL KRAMAT SAWAH VII NO 7 10110 PER/119/072016 RS.TRAUMA CENTRE

15/07/2016 30/06/2017

37 1500000001005 PUSKESMAS KELURAHAN RAWASARI

JL PRAMUKA SARI 1 RT 01/08, RAWASARI, JAKARTA PUSAT


01/06/2015 31/05/2016

38 1500000001005PUSKESMAS KELURAHAN RAWASARI

JL PRAMUKA SARI 1 RT 01/08, RAWASARI, JAKARTA PUSAT PER/110/062016

RS.TRAUMA CENTRE 15/07/2016 31/05/2017

39 1400000000198RS ISLAM JAKARTA CEMPAKA PUTIH JL CEMPAKA PUTIH TENGAH I/1 PER/117/072016

RS.TRAUMA CENTRE 20/07/2016 30/06/2017

40 1400000000198RS ISLAM JAKARTA CEMPAKA PUTIH

JL CEMPAKA PUTIH TENGAH I/1 PER/48/072015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

41 1500000000328 RS MH THAMRIN SALEMBA JALAN SALEMBA TENGAH NO 24 -28 JAKARTA PUSAT

DR MIRA ROZIATI DACHLAN


20/04/2016 28/02/2017


Periode : 01/01/2015 s/d 31/10/2016


150 / 44607-11-201606:23:31



IKS


42 1500000000328 RS MH THAMRIN SALEMBA JALAN SALEMBA TENGAH NO 24 -28 JAKARTA PUSAT

DR MIRA ROZIATI DACHLAN PER/16/032015 RS.TRAUMA

CENTRE 01/03/2015 29/02/2016

43 1400000000298 RS PERTAMINA JAYA JL.JEND.ACHMAD YANI NO 2 CEMPAKA PUTIH 4211911 PER/01/012016 RS.TRAUMA

CENTRE 05/01/2016 31/12/2016

44 1400000000298 RS PERTAMINA JAYA JL.JEND.ACHMAD YANI NO 2 CEMPAKA PUTIH


01/09/2015 31/12/2015

45 1500000000594 RS PREMIER JATINEGARA JALAN RAYA JATINEGARA TIMUR NO.85-87 JAKARTA

DR.SRI WURYATI HANDAYANI


09/06/2016 31/03/2017

46 1500000000594 RS PREMIER JATINEGARA JALAN RAYA JATINEGARA TIMUR NO.85-87 JAKARTA

DR.SRI WURYATI HANDAYANI PER/03/032015 RS.TRAUMA

CENTRE 23/03/2015 23/03/2016

47 1400000000658 RS RIDWAN MAUREKSA PER/62/122015RS.TRAUMA CENTRE 14/03/2016 30/11/2016

48 1400000000351 RSIA EVASARI JL. RAWAMANGUN NO. 27 PRAMUKA JAKARTA PUSAT 10570


01/10/2015 31/12/2015

49 1400000000351 RSIA EVASARI JL. RAWAMANGUN NO. 27 PRAMUKA JAKARTA PUSAT 10570


05/01/2016 31/12/2016

50 7-3961775343RSPAD GATOT SOEBROTO DITKESAD

JL DR ABDUL RAHMAN SALEH NO 24 SENEN JAKARTA PUSAT 10440

3441008/3511792

DR. TERAWAN AGUS PUTRANTO, SP RAD (K) RI


51 7-4000787183RSUP NASIONAL DR. CIPTO MANGUNKUSUMO

JALAN DIPONEGORO NOMOR 71 JAKARTA PUSAT 10440

3143767/1500135

DR.DR.C.H.SOEJONO,SP.PD-K.GER PER/120 /072016

RS.TRAUMA CENTRE 01/07/2016 30/06/2018

KANTOR CABANG : J02- KANTOR CABANG JAKARTA GROGOL


Periode : 01/01/2015 s/d 31/10/2016


151 / 44607-11-201606:23:31



IKS


1 1500000000861 PPKD JAKARTA BARAT JL KAMAL RAYA NO 2 TEGAL ALUR PER/09/052015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

2 1500000001684 PUSKESMAS KEC GROGOL PETAMBURAN

JL WIJAYA III BLOK F KOMP TAMAN DUTA MAS 11110 5648379 BLUD PUSKESMAS KEC

GROGOL PETAMBURAN PER/13/062015 RS.TRAUMA CENTRE 01/06/2015 30/06/2015

3 1500000001683 PUSKESMAS KEC PALMERAH

JL PALMERAH BARAT NO 120 11110 5482370 BLUD PUSKESMAS KEC PALMERAH


01/06/2015 30/06/2015

4 1500000001881 PUSKESMAS KECAMATAN KEMBANGAN

JL H. SAABA PERUM WALIKOTA BLOK C7 RT 006/RW 03 MERUYA SELATAN, JAKARTABARAT


01/07/2015 30/06/2016

5 1500000001884 PUSKESMAS KELURAHAN JOGLO I JL MESJID AL-MUBARAK II RT 02/08 11110 5840451 PER/16/072015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

6 1500000001883PUSKESMAS KELURAHAN JOGLO II

JL RAYA JOGLO RT 011/02 KOMP PEMADAMKEBAKARAN 11110 58902737 PER/16/072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

7 1500000001887 PUSKESMAS KELURAHAN KEMBANGAN SELATAN

JL RAYA KEMBANGAN RT 007/001 11110 70642117 PER/16/072015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

8 1500000001888 PUSKESMAS KELURAHAN KEMBANGAN UTARA

JL RAYA KEMBANGAN RT 005/002 11110 68534570 PER/16/072015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

9 1500000001885PUSKESMAS KELURAHAN MERUYA SELATAN I JL MERUYA SELATAN RT 07/04 11110 68534571 PER/16/072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

10 1500000001886PUSKESMAS KELURAHAN MERUYA UTARA JL RAYA MERUYA ILIR RT 05/04 11110 5843136 PER/16/072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

11 1500000001882PUSKESMAS KELURAHAN SRENGSENG

JL SRENGSENG RT 01/02 11110 68534572 PER/16/072015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

12 1500000001710 RS SILOAM KEBON JERUK JL RAYA PEJUANGAN KAV 08 KEBON JERUK JAKARTA

11530 25677888PT SILOAM INTERNATIONAL HOSPITALS


29/06/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


152 / 44607-11-201606:23:31



IKS


13 7-4399483643 RSJ DR SOEHARTO HEERDJAN

JL PROF DR LATUMENTEN NO.1 JAKARTA BARAT 11460 021568284

1DR. ARIS TAMBING, MARS IKS/27/082016 RS.TRAUMA

CENTRE 18/08/2016 31/12/2016

14 7-2354876841 RSTC DUTA INDAH JL TELUK GONG RAYA NO 12 14450 66676188 PT DUTA INDAH MEDIKA PER/05/032016 RS.TRAUMA CENTRE 07/03/2016 28/02/2017

15 1500000000516 RSTC MEDIKA PERMATA HIJAU

JL RAYA KEBAYORAN LAMA NO.64 JAKARTA BARAT


14/03/2016 28/02/2017

16 1500000000516 RSTC MEDIKA PERMATA HIJAU

JL RAYA KEBAYORAN LAMA NO.64 JAKARTA BARAT


02/03/2015 29/02/2016

17 1500000000088 RSTC ROYAL TARUMA JL DAAN MOGOT NO 34 JAKARTA 56967788 DR. LIMAN HARIJONO, MARS PER/06/032016 RS.TRAUMA

CENTRE 14/03/2016 28/02/2017

18 1500000000088 RSTC ROYAL TARUMA JL DAAN MOGOT NO 34 JAKARTA 56967788DR. LIMAN HARIJONO, MARS PER/01/012015

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

19 7-2617918393 RSTC SUMBER WARAS JL KYAI TAPA NO.1 TOMANG, GROGOL PETAMBURAN, JAKARTA BARAT

11440 021-5682011

YAYASAN RS SUMBER WARAS


22/03/2016 28/02/2017

KANTOR CABANG : J03- KANTOR CABANG JAKARTA KELAPA GADING


IKS


1 1400000000204KLINIK OILIA MEDICAL CENTRE

JL SWASEMBADA BARAT XII NO 2E KEBON BAWANG

43901357RACHYUDIN ACHMAD, SE


11/08/2016 31/07/2017

2 1400000000205 KLINIK WAHANA SEJAHTERA 2

JL KEBON BAWANG VI NO 23 TANJUNG PRIOK

92679357 AGUNG MUHAREZA PER/111/082016 RS.TRAUMA CENTRE

11/08/2016 31/07/2017


Periode : 01/01/2015 s/d 31/10/2016


153 / 44607-11-201606:23:31



IKS


3 1400000000240 KLINIK WAHANA SEJAHTERA I JL TIPAR CAKUNG SUKAPURA RT/RW 01/01 4414662 DR HADI SANTOSO PER/110/082016 RS.TRAUMA

CENTRE 11/08/2016 31/07/2017

4 1400000000241 KLINIK WAHANA SEJAHTERA III

JL WARAKAS I NO 5 RT/RW 003/001 KEL. WARAKAS 43934695 DRG HADI SANTOSO PER/112/082016 RS.TRAUMA

CENTRE 11/08/2016 31/07/2017

5 1500000001023 PUSAT PELATIHAN KERJA DAERAH JAKARTA UTARA

JL. GEREJA TUGU NO.20 SEMPER BARAT, JAKARTA UTARA

4401066 RUDOLF TAMBUNAN PER/05/2015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

6 1500000001023 PUSAT PELATIHAN KERJA DAERAH JAKARTA UTARA

JL. GEREJA TUGU NO.20 SEMPER BARAT, JAKARTA UTARA

4401066 RUDOLF TAMBUNAN PER/89/052016 RS.TRAUMA CENTRE

11/08/2016 30/04/2017

7 7-5108581303 PUSKESMAS KECAMATAN KELAPA GADING JALAN PELEPAH ELOK BLOK HF.7 14240 45853300 DRG. DINI INDRAWATI PER/120/092016 RS.TRAUMA

CENTRE 11/10/2016 31/12/2017

8 7-5111276336PUSKESMAS KELURAHAN GADING TIMUR I JALAN KOMPLEK PERDAGANGAN 14240 DRG.VERA ANDALUCYA PER/122/092016

RS.TRAUMA CENTRE 11/10/2016 31/12/2017

9 1400000000557 RS PELABUHAN JAKARTA JL KRAMAT JAYA TANJUNG PRIOK 4403026 DR. M. SYAIFUL HUDA EFFENDI, MM


02/09/2016 30/11/2016

10 1500000001818 RS SATYA NEGARA JL AGUNG UTARA RAYA BLOK A/1 JAKARTA UTARA

14250 64715200 DR. GUNAWAN SUSANTOSP.BS


01/06/2015 31/05/2016

11 1500000001818 RS SATYA NEGARAJL AGUNG UTARA RAYA BLOK A/1 JAKARTA UTARA 14250 64715200

DR. GUNAWAN SUSANTOSP.BS PER/90/052016

RS.TRAUMA CENTRE 11/08/2016 30/04/2017

12 1400000000199 RSUD KOJA JALAN DELI NO 4 TANJUNG PRIOK 43938478DR TOGI ASMAN SINAGA, MKES PER/115/082016

RS.TRAUMA CENTRE 22/08/2016 31/12/2017

13 7-2942035683RUMAH SAKIT PELABUHAN JAKARTA

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


15/04/2016 30/11/2016

14 1500000000497 RUMAH SAKIT PORT MEDICAL CENTER

JLN ENGGANO NO 10 TANJUNG PRIOK 43902350 DR R SUHARBAGYO M PER/04/032015 RS.TRAUMA CENTRE

19/03/2015 28/02/2016


Periode : 01/01/2015 s/d 31/10/2016


154 / 44607-11-201606:23:31



IKS


15 1500000000497 RUMAH SAKIT PORT MEDICAL CENTER JLN ENGGANO NO 10 TANJUNG PRIOK 43902350 DR R SUHARBAGYO M PER/19/032016 RS.TRAUMA

CENTRE 11/08/2016 28/02/2017

16 7-3812396225 RUMAH SAKIT PORT MEDICAL CENTER JL. ENGGANO 10 TANJUNG PRIOK JAKARTA 14310 43902350 DR. DEDI NUGROHO,


17 7-3933402927 RUMAH SAKIT PURI MEDIKA JALAN SUNGAI BAMBU NO.5 TANJUNG PRIOK

14320 43903355 DR.KARNAIL SINGH PER/21/032016 RS.TRAUMA CENTRE

24/06/2016 28/02/2017

18 1500000000496 RUMAH SAKIT PURI MEDIKA JALAN SUNGAI BAMBU NO.5 TANJUNG PRIOK

14320 43903355 DR KARNAIL SINGH PER/03/032015 RS.TRAUMA CENTRE

04/03/2015 28/02/2016

19 1500000000496 RUMAH SAKIT PURI MEDIKA JALAN SUNGAI BAMBU NO.5 TANJUNG PRIOK 14320 43903355 DR KARNAIL SINGH PER/21/032016 RS.TRAUMA

CENTRE 11/08/2016 28/02/2017

20 7-4383529523RUMAH SAKIT UMUM DAN PEKERJA

JALAN RAYA CAKUNG CILINCING RT.2/RW.1, SUKAPURA, CILINCING, NORTH JAKARTA CITY, SPECIAL CAPITAL REGION OF JAKARTA 14140

14140 29484848DR. EMPAT PATONAH, M.KES PER/114/082016

RS.TRAUMA CENTRE 18/08/2016 31/12/2017

21 1500000001614 RUMAH SAKIT UMUM KECAMATAN KOJA

JLN. WALANG PERMAI NO 39 KEC KOJA RSU KEC KOJA NOMOR: PER/06/072015

RS.TRAUMA CENTRE

01/07/2015 30/06/2016

22 1500000001614 RUMAH SAKIT UMUM KECAMATAN KOJA

JLN. WALANG PERMAI NO 39 KEC KOJA RSU KEC KOJA NOMOR: PER/06/072015

RS.TRAUMA CENTRE

11/10/2016 31/12/2017

23 7-5090051023RUMAH SAKIT UMUM KECAMATAN TANJUNG PRIOK

JL. BUGIS NO.3 14320 43908923DRG. TONY WIBOWO HARIANTO, M.KES PER/119/092016

RS.TRAUMA CENTRE 11/10/2016 31/12/2017

KANTOR CABANG : J04- KANTOR CABANG JAKARTA RAWAMANGUN


Periode : 01/01/2015 s/d 31/10/2016


155 / 44607-11-201606:23:31



IKS


1 7-726516517 KLINIK MITRA CAKUNG JL. BALAI RAKYAT NO. 38B CAKUNG TIMUR, JAKARTA TIMUR 13910 DR. SAID RIZAL PER/29/122015 RS.TRAUMA

CENTRE 21/12/2015 30/11/2016

2 7-725640156 KLINIK NAYAKA 09 DKI JAKARTA

JL RAYA BEKASI TIMUR NO 6 RT 01/02 KLENDER JATINEGARA KAUM 13320 29688716 PT NAYAKA ERA


3 7-722461500 KLINIK SUKMA ANGGREK JL BEKASI TIMUR RAYA KM 18 JATINEGARA - CAKUNG JAKTIM

13310 46823314 BUDIMAN PER/28/112015 RS.TRAUMA CENTRE

21/12/2015 30/11/2016

4 7-4239331974 PKM KEL BALI MESTER JL WEDANA DALAM RT 07/01 13320 85908911 PEMPROV DKI PER/85/072016 RS.TRAUMA CENTRE

01/08/2016 31/07/2017

5 7-4239460675 PKM KEL BIDARA CINA 1 JL OTISTA NO 82 13330 85903677 PEMPROV DKI PER/85/072016 RS.TRAUMA CENTRE 01/08/2016 31/07/2017

6 7-4239569834 PKM KEL BIDARA CINA 2 JL NILAM RT 13/11 13350 PEMPROV DKI PER/85/072016RS.TRAUMA CENTRE 01/08/2016 31/07/2017

7 7-4239703845 PKM KEL BIDARA CINA 3 JL TANJUNG LENGKONG RT 17/07 13350 PEMPROV DKI PER/85/072016 RS.TRAUMA CENTRE

01/08/2016 31/07/2017

8 7-4264942895 PKM KEL CIPINANG JL E1 MESJID BAITUSSALAM 13210 PEMPROV DKI PER/84/072016 RS.TRAUMA CENTRE

04/08/2016 31/07/2017

9 7-4240087666PKM KEL CIPINANG BESAR SEL 1 JL CIPINANG JAYA FF NO 8 13420 PEMPROV DKI PER/85/072016

RS.TRAUMA CENTRE 01/08/2016 31/07/2017

10 7-4240147287PKM KEL CIPINANG BESAR SEL 2 JL PANCAWARGA IV 4 13410 PEMPROV DKI PER/85/072016

RS.TRAUMA CENTRE 01/08/2016 31/07/2017

11 7-4240632258PKM KEL CIPINANG BESAR UTARA

JL CIPINANG PULO MAJA 13340 PEMPROV DKI PER/85/072016RS.TRAUMA CENTRE

01/08/2016 31/07/2017

12 7-4240632899 PKM KEL CIPINANG CEMPEDAK

JL CIPINANG CEMPEDAK IV NO 2 13330 PEMPROV DKI PER/85/072016 RS.TRAUMA CENTRE

01/08/2016 31/07/2017


Periode : 01/01/2015 s/d 31/10/2016


156 / 44607-11-201606:23:31



IKS


13 7-4240740710 PKM KEL CIPINANG MUARA JL BB I RT 06/15 13310 PEMPROV DKI PER/85/072016 RS.TRAUMA CENTRE 01/08/2016 31/07/2017

14 7-4265174746 PKM KEL JATI 1 JL PULO ASEM IV 13220 PEMPROV DKI PER/84/072016 RS.TRAUMA CENTRE 04/08/2016 31/07/2017

15 7-4265539877 PKM KEL JATI 2 JL KAPLONGAN I NO 67 13230 PEMPROV DKI PER/84/072016 RS.TRAUMA CENTRE

04/08/2016 31/07/2017

16 7-4265633368 PKM KEL JATINEGARA KAUM

JL T BADARUDIN RT 01/05 13240 PEMPROV DKI PER/84/072016 RS.TRAUMA CENTRE

04/08/2016 31/07/2017

17 7-4240816741 PKM KEL KAMPUNG MELAYU JL KEBON PALA I 13320 PEMPROV DKI PER/85/072016 RS.TRAUMA

CENTRE 01/08/2016 31/07/2017

18 7-4265703089 PKM KEL KAYU PUTIH JL PLAFON I KAMP AMBON 13240 PEMPROV DKI PER/84/072016RS.TRAUMA CENTRE 04/08/2016 31/07/2017

19 7-4207255805 PKM KEL KAYUMANIS JL KAYUMANIS II NO 27B 13120 PEMPROV DKI PER/83/072016 RS.TRAUMA CENTRE

01/08/2016 31/07/2017

20 7-4207745997 PKM KEL KEBON MANGGIS KEBON MANGGIS 13140 PEMPROV DKI PER/83/072016 RS.TRAUMA CENTRE

01/08/2016 31/07/2017

21 7-4207641556 PKM KEL PALMERIAM JL PALMERIAM RAYA NO 6A 13130 PEMPROV DKI PER/83/072016RS.TRAUMA CENTRE 01/08/2016 31/07/2017

22 7-4265983131PKM KEL PISANGAN TIMUR 1 JL GADING RAYA I 13260 PEMPROV DKI PER/84/072016

RS.TRAUMA CENTRE 04/08/2016 31/07/2017

23 7-4265783380PKM KEL PISANGAN TIMUR 2

JL H MUGENI III 13250 PEMPROV DKI PER/84/072016RS.TRAUMA CENTRE

04/08/2016 31/07/2017

24 7-4240879772 PKM KEL RAWA BUNGA JL JATINEGARA TIMUR IV 13420 PEMPROV DKI PER/85/072016 RS.TRAUMA CENTRE

01/08/2016 31/07/2017


Periode : 01/01/2015 s/d 31/10/2016


157 / 44607-11-201606:23:31



IKS


25 7-4266034652 PKM KEL RAWAMANGUN JL TAMAN JELITA UTARA 5 13250 PEMPROV DKI PER/84/072016 RS.TRAUMA CENTRE 04/08/2016 31/07/2017

26 7-4208076801 PKM KEL UTAN KAYU SELATAN 2 JL GALUR SARI RAYA 13140 PEMPROV DKI PER/83/072016 RS.TRAUMA

CENTRE 01/08/2016 31/07/2017

27 7-4207746838 PKM KEL UTAN KAYU SELATAN I

JL SKIP UJUNG 13150 PEMPROV DKI PER/83/072016 RS.TRAUMA CENTRE

01/08/2016 31/07/2017

28 7-4208193982 PKM KEL UTAN KAYU UTARA

JL KOMP KEHAKIMAN NO 96 13150 85900050 PEMPROV DKI PER/83/072016 RS.TRAUMA CENTRE

01/08/2016 31/07/2017

29 1500000001014 PUSAT PELATIHAN KERJA DAERAH JAKARTA TIMUR JALAN JATINEGARA BARAT NO 142 JAKTIM DIDIK SUPARDI PER/78/052016 RS.TRAUMA

CENTRE 24/06/2016 31/05/2017

30 1500000001014PUSAT PELATIHAN KERJA DAERAH JAKARTA TIMUR JALAN JATINEGARA BARAT NO 142 JAKTIM DIDIK SUPARDI PER/12/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

31 1500000001833 PUSKESMAS BIDARA CINA I (TC)

JL OTISTA NO 82 13110 85903677 DR WINARTO PER/13/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

32 7-4237299753 PUSKESMAS KEC JATINEGARA

JL MATRAMAN RAYA NO 220 13310 PEMPROV DKI PER/85/072016 RS.TRAUMA CENTRE

01/08/2016 31/07/2017

33 7-4206413413PUSKESMAS KEC MATRAMAN JL KEBON KELAPA RAYA NO 29 13110 PEMPROV DKI PER/83/072016

RS.TRAUMA CENTRE 01/08/2016 31/07/2017

34 1500000001850PUSKESMAS KEC MATRAMAN (TC) JL KEBON KELAPA RAYA NO 29 JAKTIM 13110 8581957

DR HERNI LESTYANINGSIH PER/15/062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

35 7-4264562823PUSKESMAS KEC PULOGADUNG

JL KAYU PUTIH SELATAN III/2B 13210 PEMPROV DKI PER/84/072016RS.TRAUMA CENTRE

04/08/2016 31/07/2017

36 1500000001707 PUSKESMAS KEC. JATINEGARA (TC)

JALAN MATRAMAN RAYA NO. 220 JAKARTA TIMUR

13110 8195146 DR. WINARTO PER/13/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


158 / 44607-11-201606:23:31



IKS


37 1500000001706 PUSKESMAS KEC. PULOGADUNG (TC)

JL. KAYU PUTIH SELATAN III/2B JAKARTA TIMUR 13110 4890519 DRG KRISTIANI DWI H. PER/14/062015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

38 1500000001837 PUSKESMAS KEL BALI MESTER JL WEDANA DALAM RT 07/01 13110 85908911 DR WINARTO PER/13/062015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

39 1500000001847 PUSKESMAS KEL CIPINANG JL E1 MASJID BAITUSSALAM 13110 4756139 DRG KRIS PER/14/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

40 1500000001843 PUSKESMAS KEL JATI 1 JL PULO ASEM IV 13110 47868535 DRG KRIS PER/14/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

41 1500000001844 PUSKESMAS KEL JATI 2 JL KAPLONGAN I NO 67 13110 4786404 DRG KRIS PER/14/062015 RS.TRAUMA CENTRE 01/07/2015 30/06/2016

42 1500000001849PUSKESMAS KEL JATINEGARA KAUM JL T BADARUDIN RT 001/05 13110 4755580 DRG KRIS PER/14/062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

43 1500000001855 PUSKESMAS KEL KAYU MANIS

JL KAYU MANIS 2 NO 27B 13110 DR HERNI L PER/15/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

44 1500000001842 PUSKESMAS KEL KAYU PUTIH

JL PLAFON I KAMP AMBON 13110 4710423 DRG KRIS PER/14/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

45 1500000001854PUSKESMAS KEL PISANGAN BARU JL KEBON SEREH BARAT 13110 8507756 DR HERNI L PER/15/062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

46 1500000001848PUSKESMAS KEL PISANGAN TIMUR I JL GADING RAYA I 13110 4755612 DRG KRIS PER/14/062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

47 1500000001846PUSKESMAS KEL PISANGAN TIMUR II

JL H MUGENI III 13110 4756139 DRG KRIS PER/14/062015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

48 1500000001839 PUSKESMAS KEL RAWA BUNGA

JL JATINEGARA TIMUR IV 13110 8511689 DR WINARTO PER/13/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


159 / 44607-11-201606:23:31



IKS


49 1500000001845 PUSKESMAS KEL RAWAMANGUN JL TAMAN JELITA UTARA 5 13110 47864411 DRG KRIS PER/14/062015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

50 1500000001853 PUSKESMAS KEL UTAN KAYU 2 JL GALUR SARI RAYA 13110 85909517 DR HERNI PER/15/062015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

51 1500000001851 PUSKESMAS KEL UTAN KAYU UTARA

JL KOMPL KEHAKIMAN NO 96 13110 85900059 DR HERNI PER/15/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

52 1500000001834 PUSKESMAS KEL. BIDARA CINA II

JL NILAM RT 013/11 13110 8571147 DR WINARTO PER/13/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

53 1500000001835 PUSKESMAS KEL. BIDARA CINA III JL TANJUNG LENGKONG RT 015/07 13110 859175874 DR WINARTO PER/13/062015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

54 1500000001841PUSKESMAS KEL. CIP. BESAR UTARA JL CIPINANG PULO MAJA 13110 7734000 DR WINARTO PER/13/062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

55 1500000001831 PUSKESMAS KEL. CIPINANG BSR SLTN I

JL CIPINANG JAYA FF NO 8 13110 8511127 DR WINARTO PER/13/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

56 1500000001832 PUSKESMAS KEL. CIPINANG BSR SLTN II

JL PANCAWARGA IV NO 04 13110 85909549 DR WINARTO PER/13/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

57 1500000001838PUSKESMAS KEL. CIPINANG CEMPEDAK JL CIPINANG CEMPEDAK IV NO 2 13110 85909474 DR WINARTO PER/13/062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

58 1500000001840PUSKESMAS KEL. CIPINANG MUARA JL BB I RT 006/015 13110 7408000 DR WINARTO PER/13/062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

59 1500000001836PUSKESMAS KEL. KP MELAYU

JL KEBON PALA I 13110 8515004 DR WINARTO PER/13/062015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

60 1500000001852 PUSKESMAS UTAN KAYU 1 JL SKIP UJUNG 13110 8500059 DR HERNI PER/15/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


160 / 44607-11-201606:23:31



IKS


61 7-728032798 RS COLUMBIA ASIA RAWAMANGUN

JL KAYU PUTIH RAYA NO. 1, PULOGADUNGJAKTIM 13210 29459999 PT AYUBA UTAMA PER/30/122015 RS.TRAUMA

CENTRE 21/12/2015 30/11/2016

62 7-4215773853 RS HARUM SISMA MEDIKA JL TARUM BARAT KALIMALANG 13560 PT HARUM SISMA MEDIKA PER/86/072016 RS.TRAUMA

CENTRE 01/08/2016 31/07/2017

63 1500000000527 RS HARUM SISMA MEDIKA JL TARUM BARAT, KALI MALANG JAKTIM 8617212 DR RULI NURUL AMAN PER/09/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

64 7-729931841 RS KHUSUS BEDAH RAWAMANGUN

JL BALAI PUSTAKA RAYA NO. 29-31 RAWAMANGUN

13220 PT EL HAKIM PER/31/122015 RS.TRAUMA CENTRE

21/12/2015 30/11/2016

65 7-3997449613 RS PUSAT OTAK NASIONAL JL. MT HARYONO KAV.11 CAWANG JAKARTA TIMUR 13630 29373377

DR. MURSYID BUSTAMI,SPS (K),KIC,MARS


66 7-1669163483 RSTC OMNI PULOMASJL. PULOMAS BARAT VI NO.20, JAKARTA TIMUR 13210 2977 9999 DR MARIA PER/01/012016

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

67 7-4264842014 RSUP PERSAHABATAN JL PERSAHABATAN RAYA NO 1 RAWAMANGUN

13210 KEMENKES PER/88/082016 RS.TRAUMA CENTRE

04/08/2016 31/08/2018

KANTOR CABANG : J05- KANTOR CABANG JAKARTA MENARA JAMSOSTEK


IKS


1 1400000000212 KLINIK PRATAMA FAKHIRAJL. MENTENG WADAS TIMUR KELURAHAN PASAR MANGGIS KECAMATAN SETIABUDI

83707368 ERIC SAPUTRA PER/07/072015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

2 7-4294153854 KLINIK PRATAMA FAKHIRA - MENTENG WADAS

JL. MENTENG WADAS TIMUR NO. 121A, KEL. PASAR MANGGIS, SETIABUDI

00000 83707368 ERIC SAPUTRA / DR. ISNINDYARTI


05/08/2016 30/06/2018


Periode : 01/01/2015 s/d 31/10/2016


161 / 44607-11-201606:23:31



IKS


3 1400000000416 KLINIK PRATAMA FAKHIRA -AL BARKAH

JL AL BARKAH NO.34 RT/RW 012/03 MANGGARAI SELATAN - TEBET 83707848 ERIC SAPUTRA PER/08/072015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

4 7-4293858763 KLINIK PRATAMA FAKHIRA AL BARKAH

JL. ALBARKAH NO.34 RT 012/03, KEL. MANGGARAI SELATAN, TEBET 12810 83707848 ERIC SAPUTRA PER/74/072016 RS.TRAUMA

CENTRE 05/08/2016 30/06/2018

5 7-4293218422 KLINIK PRIMARINISAHID METROPOLITAN RESIDENCE, JL. ANGGREK RAYA KAV. 293-295, KARET-SETIABUDI-JAKARTA SELATAN

12910 97265271 MARINI KUSUMANINGSIH


05/08/2016 30/06/2018

6 1500000000147 KLINIK PRIMARINISAHID METROPOLITAN RESIDENCE, JL ANGGREK RAYA KAV 293-295, KARET - SETIABUDI

97265271 DR MARINI KUSUMANINGSIH


01/01/2015 31/12/2015

7 7-4294309165 KLINIK UTAMA FAKHIRA JL. SAWAH LUNTO NO. 83A RT 002/001, PASAR MANGGIS - SETIABUDI 12910 83707368 ERIC SAPUTRA / DR. SITA

AYU ARUMI, SP.OG PER/75/072016 RS.TRAUMA CENTRE 05/08/2016 30/06/2018

8 1400000000459 KLINIK UTAMA FAKHIRAJL SAWAH LUNTO NO.83A RT 02 RW 01 KEL.PASAR MANGGIS - SETIABUDI 83707368 ERIC SAPUTRA PER/06/072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

9 1500000001177 RS AGUNG JL. SULTAN AGUNG NO.67 8294955 YAYASAN KAMAL PER/02/062015 RS.TRAUMA CENTRE

22/09/2016 30/06/2018

10 1500000001177 RS AGUNG JL. SULTAN AGUNG NO.67 8294955 YAYASAN KAMAL PER/02/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

11 1400000000366 RS TEBET JL MT HARYONO KAV. 13 8307540YAYASAN BINA SEHAT INTERNA PER/78/092016

RS.TRAUMA CENTRE 01/09/2016 31/08/2018

12 1400000000366 RS TEBET JL MT HARYONO KAV. 13 8307540YAYASAN BINA SEHAT INTERNA PER/09/092015

RS.TRAUMA CENTRE 01/09/2015 31/08/2016

13 7-140332933 RS. GATSU JL. GATSU 45 12910 RENI 12345677RS.TRAUMA CENTRE

27/10/2015 30/10/2015

KANTOR CABANG : J06- KANTOR CABANG JAKARTA CILANDAK


Periode : 01/01/2015 s/d 31/10/2016


162 / 44607-11-201606:23:31



IKS


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

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

2 1500000000170 KLINIK ARAS JL SRENGSENG SAWAH RT 001/009 JAGAKARSA 7869916 DR. SERI ANNI

NASUTION PER/01/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

3 7-4217610418 KLINIK CAHAYA MURNI JL KAHFI II NO 55 JAGAKARSA 12620 78890362 SYAMSIAH YUNUS PER/36/072016 RS.TRAUMA CENTRE

01/08/2016 31/07/2019

4 1500000000839 PPKD JAKARTA SELATAN JL BUNCIT RAYA NO 440 MAMPANG 7980311 LETTY LESTARI PER/03/052016 RS.TRAUMA CENTRE

02/05/2016 31/07/2016

5 1500000000839 PPKD JAKARTA SELATAN JL BUNCIT RAYA NO 440 MAMPANG 7980311 LETTY LESTARI PER/10/052015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

6 1500000000192RS BHAYANGKARA SESPIMMA POLRI

JL CIPUTAT RAYA NO 40 KEBAYORAN LAMA 7650384

DR JEKSON SURUNG SIMANJUNTAK PER/02/022015

RS.TRAUMA CENTRE 03/02/2015 03/02/2017

7 1500000000771 RS DR SUYOTO JL RC VETERAN 178 7342012 RS DR SUYOTO PER/09/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

8 1500000001524 RS FATMAWATI DI JL RS FATMAWATI CILANDAK 7501524 DR.ANDI WAHYUNINGSIH ATTAS


18/05/2015 30/04/2016

9 1500000001524 RS FATMAWATI DI JL RS FATMAWATI CILANDAK 7501524DR.ANDI WAHYUNINGSIH ATTAS PER/14/052015

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

10 1500000001524 RS FATMAWATI DI JL RS FATMAWATI CILANDAK 7501524DR.ANDI WAHYUNINGSIH ATTAS PER/60/082016

RS.TRAUMA CENTRE 25/08/2016 31/07/2018

11 1500000001524 RS FATMAWATI DI JL RS FATMAWATI CILANDAK 7501524DR.ANDI WAHYUNINGSIH ATTAS


02/05/2016 31/07/2016

12 1500000000721 RS MAYAPADA JL LEBAK BULUS I KAV 20 CILANDAK JAKARTA SELATAN

29217777 RS MAYAPADA PER/01/052016 RS.TRAUMA CENTRE

02/05/2016 31/07/2016


Periode : 01/01/2015 s/d 31/10/2016


163 / 44607-11-201606:23:31



IKS


13 1500000000721 RS MAYAPADA JL LEBAK BULUS I KAV 20 CILANDAK JAKARTA SELATAN 29217777 RS MAYAPADA PER/10/052015 RS.TRAUMA

CENTRE 28/04/2016 30/04/2016

14 1500000000721 RS MAYAPADA JL LEBAK BULUS I KAV 20 CILANDAK JAKARTA SELATAN 29217777 RS MAYAPADA PER/10/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

15 00000 RS MAYAPADA JL. LEBAK BULUS 1 KAV. 29, JAKARTA SELATAN


01/05/2015 30/04/2016

16 1500000000721 RS MAYAPADA JL LEBAK BULUS I KAV 20 CILANDAK JAKARTA SELATAN


25/08/2016 31/07/2018

17 00000 RS MAYAPADA JL. LEBAK BULUS 1 KAV. 29, JAKARTA SELATAN 29217777 RS MAYAPADA PER/10/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

18 1500000001942 RS PRIKASIHJL RS FATMAWATI RAYA NO 74 PONDOK LABU CILANDAK 12430 7504669 DR SUHARNO PER/50/092016

RS.TRAUMA CENTRE 01/09/2016 31/07/2018

19 1500000001942 RS PRIKASIH JL RS FATMAWATI RAYA NO 74 PONDOK LABU CILANDAK

12430 7504669 DR SUHARNO PER/19/082015 RS.TRAUMA CENTRE

01/09/2015 31/08/2016

20 7-3320778960 RS SETIA MITRA JL RS FATMAWATI NO 80-82 12790 DR SARASWATI PER/05/052016 RS.TRAUMA CENTRE

20/05/2016 20/04/2018

21 1500000001935RS SILOAM TB SIMAPTUPANG JL RA KARTINI NO 8 CILANDAK 12430 29531900 DR.IRNA S HARDIAWAN PER/20/082015

RS.TRAUMA CENTRE 01/09/2015 31/08/2016

22 1500000001935RS SILOAM TB SIMAPTUPANG JL RA KARTINI NO 8 CILANDAK 12430 29531900 DR.IRNA S HARDIAWAN PER/49/2016

RS.TRAUMA CENTRE 01/09/2016 31/07/2018

23 1500000000313 RSIA AULIA JL JERUK RAYA NO 15 JAGAKARSA 7270208DR GATOT SOERYO KOESUMO


03/03/2015 02/03/2016

24 7-2809599377 RSIA YADIKA RSIA YADIKA 12120 M SAPTADJI PER/59/082016 RS.TRAUMA CENTRE

25/08/2016 31/07/2018


Periode : 01/01/2015 s/d 31/10/2016


164 / 44607-11-201606:23:31



IKS


25 1500000000473 RSIA YADIKA CIPUTAT RAYA NO 5 KEBAYORAN LAMA SELATAN 7291074 RAJA DL SITORUS PER/07/2015 RS.TRAUMA

CENTRE 30/03/2015 29/03/2016

26 7-492399683 RSU KECAMATAN JAGAKARSA JL M KAHFI I NO 27A JAGAKARSA 12530 KEMENKES PER/70/102016 RS.TRAUMA

CENTRE 01/10/2016 30/09/2018

27 7-492399683 RSU KECAMATAN JAGAKARSA

JL M KAHFI I NO 27A JAGAKARSA 12530 KEMENKES PER/23/092015 RS.TRAUMA CENTRE

25/11/2015 30/09/2016

28 7-4320149160 RSU MARINIR CILANDAK JL RAYA CILANDAK KKO 12430 KOLONEL LAUT DR ANDIABDULLAH


09/08/2016 31/07/2018

KANTOR CABANG : J07- KANTOR CABANG JAKARTA GAMBIR


IKS


1 1400000000257 KLINIK SUNTER MEDICAL CENTER

JL. SUNTER KEMAYORAN KEL SUNTER JAYA NO 4 RT 2/3

6504226 TITIN SUPRIHATIN PER/07/062016 RS.TRAUMA CENTRE

03/08/2016 31/12/2018

2 7-2457507777 RSUD TARAKAN JL. KYAI CARINGIN NO.7 JAKARTA PUSAT 101503503150-000

DR. TOGI ASMAN SINAGA MKES PER/02/2016

RS.TRAUMA CENTRE 14/03/2016 31/12/2017

3 1500000001453 RUMAH SAKIT HUSADAJLN. RAYA MANGGA BESAR NO.137-139 JAKARTA PUSAT 10730 6260108 PER/06/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

4 1500000001453 RUMAH SAKIT HUSADAJLN. RAYA MANGGA BESAR NO.137-139 JAKARTA PUSAT 10730

6260108 PER/10/062016RS.TRAUMA CENTRE

01/06/2016 31/05/2017

KANTOR CABANG : J08- KANTOR CABANG JAKARTA KEBON SIRIH


Periode : 01/01/2015 s/d 31/10/2016


165 / 44607-11-201606:23:31



IKS


1 7-4800720029 KLINIK DAARUS SYIFA JALAN KH MAS MANSYUR NO 47 MENTENGJAKARTA PUSAT 00000 39831921 DRG DEVIANTY

MOESHAR PER/36/092016 RS.TRAUMA CENTRE 19/09/2016 31/12/2017

2 7-4806931329 KLINIK PRATAMA AFIA JALAN KALI PASIR NO 12 JAKARTA PUSAT 00000 DRG DEVIANTY MOESHAR PER/35/092016 RS.TRAUMA

CENTRE 19/09/2016 31/12/2017

3 1500000000518 KLINIK PRATAMA MITRA AFIA

JALAN KALI PASIR NO. 19, MENTENG PER/35/092016 RS.TRAUMA CENTRE

19/09/2016 31/12/2017

KANTOR CABANG : J09- KANTOR CABANG JAKARTA CAWANG


IKS


1 1500000000402 KLINIK 24 JAM CONDET JAYA

JL. CONDET RAYA NO 18 BATU AMPAR CONDET

081213263286

DIKI LESTARIONO PER/TC/02/012015

RS.TRAUMA CENTRE

01/01/2015 31/12/2015

2 1500000000355 KLINIK BUDHI PRATAMA JL.PONCOL NO.4 RT 01/05 KEL SUSUKAN CIRACAS

87783668 DR. PRASETYO WIDHI BUWONO

PER/TC/04/012015

RS.TRAUMA CENTRE

01/01/2015 31/12/2015

3 1500000000324KLINIK BUDI PRATAMA KALISARI JL RAYA KALI SARI NO 52 B PASAR REBO 87782670

DR.PRASETYO WIDHI BUWONO

PER/TC/05/012015

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

4 1500000000375KLINIK PRATAMA NAYAKA HUSADA 01

JL. RAYA PONDOK GEDE RUKO MOLEK 2 B KEL. LUBANG BUAYA KEC PD. GEDE 8480206 SRI NURYANTI

PER/TC/08/012015

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


JL. RAYA LAPAN RUKO PERUMAHAN CAHAYA RESIDENCE KAV 4 PEKAYON JAKARTA TIMUR

29841115 SRI NURYANTIPER/TC/09/012015

RS.TRAUMA CENTRE

01/01/2015 31/12/2015

6 1500000000356 KLINIK PRATAMA RESTU IBU

87783668 DR.PRASETYO WIDHI BUWONO

PER/TC/03/012015

RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


166 / 44607-11-201606:23:31



IKS


7 1500000000403 KLINIK PRATAMA TJAKRA 24 JAM

JL. RAYA BOGOR KM 24 NO. 35 RT001/ RW 01 KEL. SUSUKAN KEC CIRACAS 87794539 DR.DARWIN

D.TJAKRADIDJAJAPER/TC/01/012015

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

8 7-3145572913 KLINIK YADIKA CIBUBUR JL. LAPANGAN TEMBAK NO. 09 RT. 001/ 007, CIBUBUR, JAKARTA TIMUR 13740 DR. NOVITA DJUNAEDI PER/03/042016 RS.TRAUMA

CENTRE 13/05/2016 30/04/2018

9 1500000000896 PUSAT PELATIHAN KERJA KHUSUS LAS CONDET

JL RAYA CONDET NO 25 KRAMAT JATI KETUT METRIASIH PER/10/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

10 1500000001943 PUSKESMAS KECAMATAN CIPAYUNG

JL BAMBU HITAM NO 104 RT 104/04 KELURAHAN CIPAYUNG

13110 PUSKESMAS PER/13/092015 RS.TRAUMA CENTRE

01/09/2015 31/08/2016

11 1500000001962 PUSKESMAS KEL BAMBU APUS I 13130 PER/13/092015 RS.TRAUMA

CENTRE 01/09/2015 31/08/2016

12 1500000001963PUSKESMAS KEL BAMBU APUS II 13110 PER/13/092015

RS.TRAUMA CENTRE 01/09/2015 31/08/2016

13 1500000001961 PUSKESMAS KEL LUBANG BUAYA


01/09/2015 31/08/2016

14 1500000001964 PUSKESMAS KELURAHAN CEGER


01/09/2015 31/08/2016

15 1500000001966PUSKESMAS KELURAHAN CILANGKAP 13110 PER/13/092015

RS.TRAUMA CENTRE 01/09/2015 31/08/2016

16 1500000001967PUSKESMAS KELURAHAN CIPAYUNG 13110 PER/13/092015

RS.TRAUMA CENTRE 01/09/2015 31/08/2016

17 1500000001959PUSKESMAS KELURAHAN MUNJUL


01/09/2015 31/08/2016

18 1500000001960 PUSKESMAS KELURAHAN PONDOK RANGGON I


01/09/2015 31/08/2016


Periode : 01/01/2015 s/d 31/10/2016


167 / 44607-11-201606:23:31



IKS


19 1500000001958 PUSKESMAS KELURAHAN PONDOK RANGGON II 13110 PER/13/092015 RS.TRAUMA

CENTRE 01/09/2015 31/08/2016

20 1500000001965 PUSKESMAS KELURAHAN SETU 13110 PER/13/092015 RS.TRAUMA

CENTRE 01/09/2015 31/08/2016

21 1300000000052 RS.UKI JL. MAYJEN SUTOYO NO. 2 CAWANG 8092317 YAYASAN RS.UKI PER /05 /072016 RS.TRAUMA CENTRE

28/07/2016 31/12/2017

22 1300000000052 RS.UKI JL. MAYJEN SUTOYO NO. 2 CAWANG 8092317 YAYASAN RS.UKI PER/TC/12/052015

RS.TRAUMA CENTRE

02/05/2015 02/05/2016

23 7-2448782290 RSUD BUDHI ASIH JALAN DEWI SARTIKA CAWANG III NO. 200 JAKARTA TIMUR 13630 DR. IDA BAGUS NYOMAN

BANJAR, MKM PER/01/032016 RS.TRAUMA CENTRE 08/03/2016 31/12/2016

24 7-3992370723RUMAH SAKIT BHAYANGKARA TK.I R. SAID SUKANTO

JALAN RAYA BOGOR KRAMAT JATI JAKARTA TIMUR 13510

BRIGADIR JENDERAL POLISI DR. DIDI AGUS MINTADI, SP. JP, DFM


25 1500000000082 RUMAH SAKIT HARAPAN BUNDA

JL. RAYA BOGOR KM 22 NO 44 PASAR REBO 8400257 DRG EDDY SUHARSO,SH,M.KES


04/10/2016 31/12/2017

KANTOR CABANG : J0P- KANTOR CABANG JAKARTA SLIPI


IKS


1 1500000000326 RS BHAKTI MULYAJL AIPDA KS TUBUN NO 79 SLIPI JAKARTA BARAT

5481625 RS BHAKTI MULYA PER/07/042016RS.TRAUMA CENTRE

29/07/2016 31/12/2017

2 1500000000326 RS BHAKTI MULYA JL AIPDA KS TUBUN NO 79 SLIPI JAKARTA BARAT

5481625 RS BHAKTI MULYA PER/05/032015 RS.TRAUMA CENTRE

16/03/2015 16/03/2016


Periode : 01/01/2015 s/d 31/10/2016


168 / 44607-11-201606:23:31



IKS


3 1500000000326 RS BHAKTI MULYA JL AIPDA KS TUBUN NO 79 SLIPI JAKARTA BARAT 5481625 RS BHAKTI MULYA PER/05/032015 REIMBURSE 16/03/2015 16/03/2016

4 1400000000303 RS PELNI JL AIPDA KS TUBUN 92-94 10210 5485870 PT PELNI PER/09/092015 RS.TRAUMA CENTRE 27/01/2016 31/12/2016

KANTOR CABANG : J10- KANTOR CABANG JAKARTA PLUIT


IKS


1 1500000000903PUSKESMAS KECAMATAN PENJARINGAN JL RAYA TELUK GONG NO 2, PENJARINGAN 6694917 FLORIDA MASNIARI S

PER/01/TC/052015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

2 1500000000902 PUSKESMAS KELURAHAN KAMAL MUARA

JL KAMAL MUARA RT 07/01 55959125 DR INDRA DARMA PER/01/TC/052015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

3 1500000000901 PUSKESMAS KELURAHAN KAPUK MUARA

JL KAPUK KAMAL NO 28 6678173 DRG WIDYANINGSIH PER/01/TC/052015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

4 1500000000897PUSKESMAS KELURAHAN PEJAGALAN

JL TELUK GONG KAV RT 003/12, PENJARINGAN 6616245 DRG MARIA PATRICIA M

PER/01/TC/052015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

5 1500000000899PUSKESMAS KELURAHAN PENJARINGAN I JL RAYA PLUIT SELATAN NO 2 669377 TRI

PER/01/TC/052015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

6 1500000000900PUSKESMAS KELURAHAN PLUIT

JL MUARA ANGKE 6678173PER/01/TC/052015

RS.TRAUMA CENTRE

01/05/2015 31/05/2016

7 1500000000898 PUSKESMAS PENJARINGAN II

JL RAWA BEBEK PASAR ROYAL 66696407 KEMALA PER/01/TC/052015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


169 / 44607-11-201606:23:31



IKS


8 1300000000038 RS ATMAJAYA JL PLUIT RAYA NO 2 14440 6606127 YAYASAN ATMAJAYA PER/02/TC/052015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

9 1300000000038 RS ATMAJAYA JL PLUIT RAYA NO 2 14440 6606127 YAYASAN ATMAJAYA PER/01/TC/062016

RS.TRAUMA CENTRE 28/07/2016 31/05/2017

10 7-4619786333 RS ROYAL PROGRESS, SUNTER

JL DANAU SUNTER UTARA, SUNTER PARADISE 1

14350 06400261 DERICE A. SUMANTRI PER/06/TC/082016

RS.TRAUMA CENTRE

14/09/2016 31/12/2017

KANTOR CABANG : J11- KANTOR CABANG TANGERANG BATUCEPER


IKS


1 1500000001828 KLINIK AL HUSAENI JL RAYA MAUK KM 16 BUARAN JATI RT02/03

15211 08170799749

DR HJ SITI MAKIAH PER/22/072015 RS.TRAUMA CENTRE

01/08/2015 31/07/2016

2 1500000001828 KLINIK AL HUSAENI JL RAYA MAUK KM 16 BUARAN JATI RT02/03

15211 08170799749

DR HJ SITI MAKIAH PER/24/082016 RS.TRAUMA CENTRE

29/08/2016 31/07/2017

3 1500000001261 KLINIK ARMADA MEDIKA I JL. KAPUK KAMAL RAYA NO. 34 LT.2 11720DR. ROBBY HILMAN M. SP.M,SPKL PER/016/062016

RS.TRAUMA CENTRE 09/06/2016 31/05/2017

4 1500000001261 KLINIK ARMADA MEDIKA I JL. KAPUK KAMAL RAYA NO. 34 LT.2 11720DR. ROBBY HILMAN M. SP.M,SPKL PER/012/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

5 1500000001262 KLINIK ARMADA MEDIKA III JL. KAPUK KAMAL RAYA NO. 34 LT.1 1172002155964117

DR. ROBBY HILMAN M. SP.M,SPKL


09/06/2016 31/05/2017

6 1500000001262 KLINIK ARMADA MEDIKA III JL. KAPUK KAMAL RAYA NO. 34 LT.1 11720 02155964117

DR. ROBBY HILMAN M. SP.M,SPKL


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


170 / 44607-11-201606:23:31



IKS


7 1500000001265KLINIK DOKTER PRAKTEK PERORANGAN DR TRI SUPRAPTI HANDAJANI,MM

JL. CENDRAWASIH RAYA 2 CENGKARENG BARAT 11720 7311750 DRDR. TRI SUPRAPTI

HANDAJANI, MM PER/014/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

8 1500000001265KLINIK DOKTER PRAKTEK PERORANGAN DR TRI SUPRAPTI HANDAJANI,MM

JL. CENDRAWASIH RAYA 2 CENGKARENG BARAT 11720 7311750 DRDR. TRI SUPRAPTI

HANDAJANI, MM PER/018/062016 RS.TRAUMA CENTRE 09/06/2016 31/05/2017

9 1500000001264 KLINIK DR HARYANI JL. KAPUK KAMAL RAYA, RAWA MELATI NO. 47 JAKARTA BARAT

11720 DR HARYANI PER/010/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

10 1500000001264 KLINIK DR HARYANI JL. KAPUK KAMAL RAYA, RAWA MELATI NO. 47 JAKARTA BARAT

11720 DR HARYANI PER/017/062016 RS.TRAUMA CENTRE

09/06/2016 31/05/2017

11 7-587445633 KLINIK DUTA MEDIKA JL. DAAN MOGOT KM. 20 KEBON BESAR BATU CEPER TANGERANG 15211 DR DEDDY DASUKI,


12 1500000001263KLINIK KAINA HEALTH CARE JL. PETA SELATAN NO. 6 KALIDERES 11720

0817770753 DR. MELANIE HUSNA PER/019/062016

RS.TRAUMA CENTRE 09/06/2016 31/05/2017

13 1500000001263 KLINIK KAINA HEALTH CARE

JL. PETA SELATAN NO. 6 KALIDERES 11720 0817770753

DR. MELANIE HUSNA PER/ 009 /062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

14 1500000001288 KLINIK MEDIKA BINA SEJAHTERA

JL. KOSAMBI UTARA RAYA BLOK E1 NO. 11 A

11210 DR ATHENAWATI UNANG


09/06/2016 31/05/2017

15 07321KLINIK MEDIKA BINA SEJAHTERA JL KOSAMBI UTARA RAYA BLOK E1 NO 11A 5447798

DR ATHENAWATI UNANG PER/013/062015 KAPITASI 01/06/2015 31/05/2016

16 1500000001288KLINIK MEDIKA BINA SEJAHTERA

JL. KOSAMBI UTARA RAYA BLOK E1 NO. 11 A 11210

DR ATHENAWATI UNANG PER/013/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

17 1500000000145KLINIK PRATAMA MH THAMRIN CENGKARENG

JL DAAN MOGOT KM 17 NO 69 RT02/04 KLDRS

11720 DR SITI MAKIAHPER/02/TC/022015

RS.TRAUMA CENTRE

01/02/2015 31/01/2016

18 1500000000145 KLINIK PRATAMA MH THAMRIN CENGKARENG

JL DAAN MOGOT KM 17 NO 69 RT02/04 KLDRS

11720 DR SITI MAKIAH PER/003/012016 RS.TRAUMA CENTRE

01/02/2016 31/01/2017


Periode : 01/01/2015 s/d 31/10/2016


171 / 44607-11-201606:23:31



IKS


19 1500000001812 KLINIK PRATAMA MH THAMRIN KALIDERES

JL PETA SELATAN RUKO INDAH KALIDERES BLOK A2/2 KLDRS JAKBAR 11110 5456027 DR SITI MAKIAH PER/015/062015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

20 1500000001812 KLINIK PRATAMA MH THAMRIN KALIDERES

JL PETA SELATAN RUKO INDAH KALIDERES BLOK A2/2 KLDRS JAKBAR 11110 5456027 DR SITI MAKIAH PER/021/072016 RS.TRAUMA

CENTRE 20/07/2016 30/06/2017

21 7-757562796 KLINIK PRATAMA NAYAKA HUSADA 04 DKI

RUKO 100 JL KP MELAYU SALEMBARAN KPBISKEN RT 01/RW13 KP MELAYU TIMUR

15141 SRI NURYANTI PER/027/102015 RS.TRAUMA CENTRE

02/12/2015 30/09/2016

22 1400000000530 KLINIK PRATAMA NAYAKA HUSADA 04 DKI

JL TANGKAS BARU NO 1 JAKARTA SELATAN

SRI NURYANTI PER/027/102015 RS.TRAUMA CENTRE

01/10/2015 30/09/2016

23 7-757562796 KLINIK PRATAMA NAYAKA HUSADA 04 DKI

RUKO 100 JL KP MELAYU SALEMBARAN KPBISKEN RT 01/RW13 KP MELAYU TIMUR 15141 SRI NURYANTI PER/28/092016 RS.TRAUMA

CENTRE 01/10/2016 30/09/2017

24 7-2709100583 KLINIK SEMANAN JL SEMANAN RAYA NO 23 RT 001/002 11720 DR JOHAN PER/008/032016RS.TRAUMA CENTRE 01/04/2016 31/03/2017

25 7-589033023 KLINIK YADIKA TEGAL ALUR

JL. KAMAL RAYA BLOK H.7 NO. 7 - 11, TEGAL ALUR KALIDERES

11710 DR SAPTAJI PER/025/102015 RS.TRAUMA CENTRE

30/11/2015 31/10/2016

26 7-1459450363 RS HERMINA DAAN MOGOT JL KINTAMANI RAYA NO 2 DAAN MOGOT BARU

11710 DR I ICHSAN HANAFI MARS


22/01/2016 17/01/2017

27 1500000000146RS KARANG TENGAH MEDIKA

JL KARYAWAN IV CILEDUG KARANG TENGAH 15211 7336699 DR HENDRIK SULO MKES PER/005/012016

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

28 1500000000146RS KARANG TENGAH MEDIKA

JL KARYAWAN IV CILEDUG KARANG TENGAH 15211 7336699 DR HENDRIK SULO MKES

PER/01/TC/022015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

29 1500000001260 RS MITRA HUSADAJL KAMPUNG MELAYU BARAT NO 11 A TELUK NAGA

15128082125449938

DR HENDRY WIJAYA PER/007/052015RS.TRAUMA CENTRE

01/05/2015 30/04/2016

30 1500000001260 RS MITRA HUSADA JL KAMPUNG MELAYU BARAT NO 11 A TELUK NAGA

15128 082125449938

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

02/05/2016 30/04/2017


Periode : 01/01/2015 s/d 31/10/2016


172 / 44607-11-201606:23:31



IKS


31 7-3175908453 RSK DR SITANALA TANGERANG JL DR SITANALA NO 99 KOTA TANGERANG 15211 DR ALI MUCHTAR SP PK


32 1400000000006 RSUD CENGKARENG JL KAMAL RAYA BUMI CENGKARENG INDAH 11710 54382793 DR SUGINO KESUMA PER/033/122015 RS.TRAUMA

CENTRE 30/12/2015 30/11/2016

33 1500000001976 RUMAH SAKIT IBU DAN ANAK BUN

JL KOSAMBI RAYA NO 2 TANGERANG 15211 02170610735

DR ELIYANAH PER/01/RSTC/102015

RS.TRAUMA CENTRE

15/10/2015 14/10/2016

34 1500000001976 RUMAH SAKIT IBU DAN ANAK BUN

JL KOSAMBI RAYA NO 2 TANGERANG 15211 02170610735

DR ELIYANAH PER/25/092016 RS.TRAUMA CENTRE

15/10/2016 14/10/2017

KANTOR CABANG : J12- KANTOR CABANG JAKARTA PULOGADUNG


IKS


1 7-4985614563 KLINIK CEMPAKA 24 JAM PULOGEBANG

JL. RAYA PULOGEBANG NO. 86 13950 0214801980

ADI HARJA KUSUMAH PER/36/092016 RS.TRAUMA CENTRE

29/09/2016 31/12/2018

2 7-4045400303 KLINIK IBIN SINA JALAN PENDIDIKAN RAYA NO. 33 13440 86603270 DR. ABBAS THALIB PER/32/072016RS.TRAUMA CENTRE 13/07/2016 31/12/2018

3 1400000000305 KLINIK JEPEKA NARADA 03 JALAN TANGKAS BARU NO 1 5260729 PER/35/092016RS.TRAUMA CENTRE 04/10/2016 31/12/2017

4 1500000000841PUSAT PELATIHAN KERJA PENGEMBANGAN INDUSTRI (PPKPI) PASAR REBO

JL RAYA BOGOR KM 23 PASAR REBO 8400724 ANWIR ISMAIL SE, MM PER/34/082016RS.TRAUMA CENTRE

26/08/2016 31/12/2018

5 1500000000841PUSAT PELATIHAN KERJA PENGEMBANGAN INDUSTRI (PPKPI) PASAR REBO

JL RAYA BOGOR KM 23 PASAR REBO 8400724 ANWIR ISMAIL SE, MM PER/06/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


173 / 44607-11-201606:23:31



IKS


6 1500000001859 PUSKESMAS KECAMATAN CAKUNG JL RAYA BEKASI KM.18 13930 4614700 PER/12/072015 FFS 06/07/2015 30/06/2016

7 1500000001859 PUSKESMAS KECAMATAN CAKUNG JL RAYA BEKASI KM.18 13930 4614700 PER/32/072016 RS.TRAUMA

CENTRE 29/08/2016 31/12/2018

8 1500000001861 PUSKESMAS KELURAHAN CAKUNG BARAT

JL RAYA TIPAR CAKUNG BARAT 13910 46829709 PER/12/072015 FFS 06/07/2015 30/06/2016

9 1500000001861 PUSKESMAS KELURAHAN CAKUNG BARAT

JL RAYA TIPAR CAKUNG BARAT 13910 46829709 PER/32/072016 RS.TRAUMA CENTRE

29/08/2016 31/12/2018

10 1500000001863 PUSKESMAS KELURAHAN CAKUNG TIMUR JL BALAI RAKYAT NO 87 13910 4682910 PER/12/072015 FFS 06/07/2015 30/06/2016

11 1500000001863PUSKESMAS KELURAHAN CAKUNG TIMUR JL BALAI RAKYAT NO 87 13910 4682910 PER/32/072016

RS.TRAUMA CENTRE 29/08/2016 31/12/2018

12 1500000001867 PUSKESMAS KELURAHAN JATINEGARA

JL RAYA BEKASI KM 17 13920 4612345 PER/12/072015 FFS 06/07/2015 30/06/2016

13 1500000001867 PUSKESMAS KELURAHAN JATINEGARA

JL RAYA BEKASI KM 17 13920 4612345 PER/32/072016 RS.TRAUMA CENTRE

29/08/2016 31/12/2018

14 1500000001868PUSKESMAS KELURAHAN PENGGILINGAN ELOK PERUMAHAN ANEKA ELOK 13920 4807827 PER/32/072016

RS.TRAUMA CENTRE 29/08/2016 31/12/2018

15 1500000001868PUSKESMAS KELURAHAN PENGGILINGAN ELOK PERUMAHAN ANEKA ELOK 13920 4807827 PER/12/072015 FFS 06/07/2015 30/06/2016

16 1500000001864PUSKESMAS KELURAHAN PENGGILINGAN PIK

KOMP PIK PENGGILINGAN 13940 46829710 PER/12/072015 FFS 06/07/2015 30/06/2016

17 1500000001864 PUSKESMAS KELURAHAN PENGGILINGAN PIK

KOMP PIK PENGGILINGAN 13940 46829710 PER/32/072016 RS.TRAUMA CENTRE

29/08/2016 31/12/2018


Periode : 01/01/2015 s/d 31/10/2016


174 / 44607-11-201606:23:31



IKS


18 1500000001865 PUSKESMAS KELURAHAN PULOGEBANG JL RAYA STASIUN KM 4 CAKUNG 13940 4807828 PER/12/072015 FFS 06/07/2015 30/06/2016

19 1500000001865 PUSKESMAS KELURAHAN PULOGEBANG JL RAYA STASIUN KM 4 CAKUNG 13940 4807828 PER/32/072016 RS.TRAUMA

CENTRE 29/08/2016 31/12/2018

20 1500000001862 PUSKESMAS KELURAHAN RAWA TERATAI

JL RAYA BEKASI KM 21 CAKUNG 13920 46829720 PER/32/072016 RS.TRAUMA CENTRE

29/08/2016 31/12/2018

21 1500000001862 PUSKESMAS KELURAHAN RAWA TERATAI

JL RAYA BEKASI KM 21 CAKUNG 13920 46829720 PER/12/072015 FFS 06/07/2015 30/06/2016

22 1500000001860 PUSKESMAS KELURAHAN UJUNG MENTENG JL RAYA BEKASI KM.26 13960 46828217 PER/12/072015 FFS 06/07/2015 30/06/2016

23 1500000001860PUSKESMAS KELURAHAN UJUNG MENTENG JL RAYA BEKASI KM.26 13960 46828217 PER/32/072016

RS.TRAUMA CENTRE 29/08/2016 31/12/2018

24 1500000000247 RS ANTAM MEDIKA JL RAYA PEMUDA NO 1A 29378939 PER/TC/01/032015

RS.TRAUMA CENTRE

01/03/2015 29/02/2016

25 1500000000247 RS ANTAM MEDIKA JL RAYA PEMUDA NO 1A 29378939 PER /08/032016 RS.TRAUMA CENTRE

15/03/2016 28/02/2018

26 1200000000004 RS HARAPAN JAYAKARTAJL BEKASI TIMUR RAYA NO 6 KM 18 PULOGADUNG 13210 4603916 DR. SRI HARTATI

PER/TC/01/012016

RS.TRAUMA CENTRE 01/08/2016 30/12/2016

27 1200000000004 RS HARAPAN JAYAKARTAJL BEKASI TIMUR RAYA NO 6 KM 18 PULOGADUNG 13210 4603916 DR. SRI HARTATI

PER/TC/01/012015

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

28 1100000000029RSTC RS ISLAM PONDOK KOPI

JALAN RAYA PONDOK KOPI 8610471 PER/27/062016RS.TRAUMA CENTRE

01/06/2016 31/05/2018

29 1100000000029 RSTC RS ISLAM PONDOK KOPI

JALAN RAYA PONDOK KOPI 8610471 PER/11/052015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


175 / 44607-11-201606:23:31



IKS


30 7-3997416836 RUMAH SAKIT KHUSUS DAERAH DUREN SAWIT

JL. DUREN SAWIT BARU NO. 2 JAKARTA TIMUR, DKI JAKARTA, INDONESIA 13450 021861555

5

DR. JULAGA HC LUMBANTOBING, MARSRUMAH SAKIT KHUSUS DAERAH DUREN SAWIT


KANTOR CABANG : J13- KANTOR CABANG JAKARTA KEBAYORAN BARU


IKS


1 1500000000476 RS GANDARIA JLN GANDARIA TENGAH II NO 6-14 JAK SEL 7203311 DR .H.J ROESLANI S,SP THT 05/042015 RS.TRAUMA

CENTRE 01/04/2015 01/04/2016

2 1500000000476 RS GANDARIA JLN GANDARIA TENGAH II NO 6-14 JAK SEL 7203311DR .H.J ROESLANI S,SP THT PER/01/042016

RS.TRAUMA CENTRE 20/04/2016 31/03/2017

KANTOR CABANG : J14- KANTOR CABANG JAKARTA CILINCING


IKS


1 1500000000656 KLINIK PERMATA MEDIKA 1 EMPER RAYA NO.22 RT.010/002 4303619 DR.EMPAT PATONAH 02/2015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

2 7-5304417403PUSKESMAS KECAMATAN KOJA

JLN MAHONI SELATAN NO 9 14210 43905753DINAS KESEHATAN JAKARTA UTARA


28/10/2016 31/12/2017

3 7-5331336053 PUSKESMAS KELURAHAN KOJA

JLN DELI GG 28 NO 2 JAKARTA UTARA 14210 43901718 DINAS KESEHATAN JAKARTA UTARA


28/10/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


176 / 44607-11-201606:23:31



IKS


4 7-5331616014 PUSKESMAS KELURAHAN LAGOA JLN MENTENG NO 30 JAKARTA UTARA 14210 43901718 DINAS KESEHATAN

JAKARTA UTARA PER/07/092016 RS.TRAUMA CENTRE 28/10/2016 31/12/2017

5 7-5333259009 PUSKESMAS KELURAHAN RAWA BADAK SELATAN PLUMPANG B JALAN K2 NO 7 14210 43901718 DINAS KESEHATAN

JAKARTA UTARA PER/07/092016 RS.TRAUMA CENTRE 28/10/2016 31/12/2017

6 7-5332908617 PUSKESMAS KELURAHAN RAWA BADAK UTARA I

JLN RAWA BADAK BARAT NO 37 14210 43933827 DINAS KESEHATAN JAKARTA UTARA


28/10/2016 31/12/2017

7 7-5333122568 PUSKESMAS KELURAHAN RAWA BADAK UTARA II

JLN RAWA BINANGUN I JAKARTA UTARA 14210 43901718 DINAS KESEHATAN JAKARTA UTARA


28/10/2016 31/12/2017

8 7-5332301116 PUSKESMAS KELURAHAN TUGU SELATAN JLN BENDUNGAN MELAYU SELATAN 14210 021651254

1DINAS KESEHATAN JAKARTA UTARA PER/07/092016 RS.TRAUMA

CENTRE 28/10/2016 31/12/2017

9 7-5332106265PUSKESMAS KELURAHAN TUGU UTARA III JLN KRAMAT JAYA GG VIII 14210 43901718

DINAS KESEHATAN JAKARTA UTARA PER/07/092016

RS.TRAUMA CENTRE 28/10/2016 31/12/2017

10 1500000000591 RS ISLAM JAKARTA SUKAPURA


01/04/2015 31/03/2016

11 1500000000591 RS ISLAM JAKARTA SUKAPURA


11/08/2016 31/12/2016

12 1500000000290 RS. FIRDAUSKOMP BEA CUKAI JL SIAK J5/14 JAKARTA UTARA 4407322 DR UNTUNG SUGIHARTO PER/01/2015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

KANTOR CABANG : J15- KANTOR CABANG JAKARTA MANGGA DUA


Periode : 01/01/2015 s/d 31/10/2016


177 / 44607-11-201606:23:31



IKS


1 1500000001347 PUSKESMAS KECAMATAN TAMANSARI

JL MADU NO.10 MANGGABESAR TAMANSARI 6247319 DR HERWIN MEIFENDY PER/007/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

2 1500000001350 PUSKESMAS KELURAHAN KEAGUNGAN JL KEBON SAYUR I NO.6 6281130 PER/007/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

3 1500000001362 PUSKESMAS KELURAHAN KRUKUT

JL KRUKUT LIO 6319817 PER/007/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

4 1500000001349 PUSKESMAS KELURAHAN MANGGA BESAR

JL BLUSTRU NO.16 6595342 DR HERWIN PER/007/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

5 1500000001351 PUSKESMAS KELURAHAN MAPHAR JL KEBON JERUK X 6592603 PER/007/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

6 1500000001348PUSKESMAS KELURAHAN TAMANSARI JL MANGGA BESAR XIII 6247319 DR HERWIN M PER/007/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

7 1500000000596 RSU KECAMATAN PADEMANGAN

JL BUDI MULYA RAYA PADEMANGAN 6452346 DR SITI RACHMI PER/005/042015 RS.TRAUMA CENTRE

01/04/2015 31/12/2015

8 7-4232895591 RUMAH SAKIT UMUM PADEMANGAN

JL. BUDI MULIA RAYA 2 ANCOL PEDEMANGAN

14420 0216452346

PEMDA DKI PER/04/062016 RS.TRAUMA CENTRE

04/08/2016 01/06/2017

KANTOR CABANG : J16- KANTOR CABANG JAKARTA SUDIRMAN


IKS


1 7-3559719973 KLINIK PRATAMA NAYAKA HUSADA 02

JL. GATOT SUBROTO LT GROUND 12120 SRI NURYANTI PKS/014/022016 RS.TRAUMA CENTRE

31/05/2016 01/02/2017


Periode : 01/01/2015 s/d 31/10/2016


178 / 44607-11-201606:23:31



IKS


2 2015000000001 KLINIK PRATAMA NAYAKA HUSADA 02 JL GATOT SUBROTO LANTAI GROUND 5207797 PER/TC/08/0120

15RS.TRAUMA CENTRE 01/04/2015 31/12/2015

3 2015000000002 RS JAKARTA JLN GARNISUN NO 1 JEND SUDIRMAN 5732241 PT JASMETRA 001/MKT/IKS-MITRA/3/2015

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

4 2015000000002 RS JAKARTA JLN GARNISUN NO 1 JEND SUDIRMAN 5732241 PT JASMETRA 011/MKT/IKS-MITRA-VI/2016

RS.TRAUMA CENTRE

01/07/2016 31/12/2016

KANTOR CABANG : J17- KANTOR CABANG JAKARTA MAMPANG


IKS


1 1502201500002 KLINIK RESTU IBU II JL. SWADAYA NO. 54 PEJATEN JAKARTA SELATAN

78840267 DR. PRASETYO WIDHI BUWONO,SP.PD


01/02/2015 31/01/2016

2 1806201500004 RS ZAHIRAH JL. SIRSAK NO.21 JAGAKARSA JAKARTA SELATAN

7872210 ROBI HARI SETIAWAN,SE,MM


01/05/2015 30/04/2016

3 1806201500004 RS ZAHIRAHJL. SIRSAK NO.21 JAGAKARSA JAKARTA SELATAN 7872210

ROBI HARI SETIAWAN,SE,MM PER/04/032016

RS.TRAUMA CENTRE 01/06/2016 30/04/2017

4 1806201500004 RS ZAHIRAHJL. SIRSAK NO.21 JAGAKARSA JAKARTA SELATAN 7872210

ROBI HARI SETIAWAN,SE,MM

001/RSZ-DIR/PKS/VI/2015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

5 2505201500003RSU KECAMATAN MAMPANG PRAPATAN

JL. KAPTEN TENDEAN NO.9 JAKARTA SELATAN

79192187DR. DEWI SRI RACHMAWATI SP.A


21/05/2015 20/05/2016

6 2505201500003 RSU KECAMATAN MAMPANG PRAPATAN

JL. KAPTEN TENDEAN NO.9 JAKARTA SELATAN

79192187 DR. DEWI SRI RACHMAWATI SP.A


10/06/2016 30/06/2017


Periode : 01/01/2015 s/d 31/10/2016


179 / 44607-11-201606:23:31



IKS


7 7-4254028679 RSUD PASAR MINGGU TB SIMATUPANG NO 1 12550 29059999 RSUD PASAR MINGGU PER/07/06-2016 RS.TRAUMA CENTRE 03/08/2016 01/07/2018

8 7-5189727365 RUMAH SAKIT SILOAM ASRI JL DUREN TIGA RAYA NO 20 RT 004 RW 001 12790 27837900 RS SILOAM ASRI PER/09/2016 RS.TRAUMA

CENTRE 17/10/2016 06/10/2018

KANTOR CABANG : K00- KANTOR CABANG BANDUNG SUCI


IKS


1 1500000001896 BIOFIT HEALTH CENTER JL. WR SUPRATMAN NO. 69, BANDUNG 40114 7271451 NENDEN SUHARTINI PER/25/0715RS.TRAUMA CENTRE 01/07/2015 31/12/2015

2 1500000001896 BIOFIT HEALTH CENTER JL. WR SUPRATMAN NO. 69, BANDUNG 40114 7271451 NENDEN SUHARTINI PER/01/012016 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

3 1500000000837 KLINIK KIMIA FARMA 14 JL. CIHAMPELAS 7 BANDUNG 4201596 PT KIMIA FARMA (PERSERO) TBK


01/05/2015 31/12/2015

4 1500000000837 KLINIK KIMIA FARMA 14 JL. CIHAMPELAS 7 BANDUNG 4201596PT KIMIA FARMA (PERSERO) TBK PER/09/012016

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

5 1500000000834 KLINIK KIMIA FARMA 51 JL.IR.H.JUANDA 69 BANDUNG 4203331PT KIMIA FARMA (PERSERO) TBK PER/17/052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

6 1500000000834 KLINIK KIMIA FARMA 51 JL.IR.H.JUANDA 69 BANDUNG 4203331PT KIMIA FARMA (PERSERO) TBK


04/01/2016 31/12/2016

7 1500000000835 KLINIK KIMIA FARMA SETIABUDI

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


04/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


180 / 44607-11-201606:23:31



IKS


8 1500000000835 KLINIK KIMIA FARMA SETIABUDI JL.SETIABUDI 36 BANDUNG 2038048 PT KIMIA FARMA

(PERSERO) TBK PER/17/052015 RS.TRAUMA CENTRE 01/05/2015 31/12/2015

9 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

10 1500000000836 KLINIK KIMIA FARMA SINDANGLAYA

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


01/05/2015 31/12/2015

11 1500000000859 KLINIK ALIVIA MEDIKA JL. PASUNDAN NO. 107, BANDUNG 87805328 YUDI PRIHARTANTO PER/15/ 042015 RS.TRAUMA CENTRE

01/04/2015 31/12/2015

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

13 1500000000860 KLINIK AMANAH JL. PHH MUSTOFA NO. 124, BANDUNG. 7279705 YUDI PRIHARTANTO PER/18/ 052015RS.TRAUMA CENTRE 01/05/2015 31/12/2015

14 1500000000860 KLINIK AMANAH JL. PHH MUSTOFA NO. 124, BANDUNG. 7279705 YUDI PRIHARTANTO PER/03/012016 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

15 1500000000805 KLINIK BINA MASYARAKAT SEHAT (BMS)

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


01/05/2015 31/12/2015

16 1500000000805KLINIK BINA MASYARAKAT SEHAT (BMS) JL. AH NASUTION NO. 96 A BANDUNG 7801861

DR H YONO SUDIYONO MARS, MHKES PER/04/012016

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

17 1500000000855 KLINIK HIKMAHJL. PESANTREN NO. 8A, RT 01/04, KELURAHAN SUKAMISKIN, KECAMATAN ARCAMANIK, BANDUNG

814 254 80 DRG NIA LESTARI PER/12/042015RS.TRAUMA CENTRE 01/04/2015 31/12/2015

18 1500000000855 KLINIK HIKMAHJL. PESANTREN NO. 8A, RT 01/04, KELURAHAN SUKAMISKIN, KECAMATAN ARCAMANIK, BANDUNG

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

04/01/2016 26/10/2016

19 1500000000854 KLINIK HIKMAH DUA JL. IBRAHIM AJI NO. 145, KIARA CONDONG, BANDUNG

81525480 NANO ROHANA PER/06/012016 RS.TRAUMA CENTRE

04/01/2016 26/10/2016


Periode : 01/01/2015 s/d 31/10/2016


181 / 44607-11-201606:23:31



IKS


20 1500000000854 KLINIK HIKMAH DUA JL. IBRAHIM AJI NO. 145, KIARA CONDONG, BANDUNG 81525480 NANO ROHANA PER/13/042015 RS.TRAUMA

CENTRE 01/04/2015 31/12/2015

21 1500000000585 KLINIK ITENAS JALAN PHH MUSTOFA NO. 23 , BANDUNG PT. RS PADJADJARAN PER/004/04/2015 RS.TRAUMA CENTRE 01/04/2015 31/12/2015

22 1500000000585 KLINIK ITENAS JALAN PHH MUSTOFA NO. 23 , BANDUNG PT. RS PADJADJARAN PER/07/012016 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

23 1500000000584 KLINIK KIARA HUSADA JALAN IBRAHIM ADJIE NO. 25 (TERS KIRCON) BANDUNG

7564929 PT RUMAH SAKIT PADJADJARAN


01/04/2015 31/12/2015

24 1500000000584 KLINIK KIARA HUSADA JALAN IBRAHIM ADJIE NO. 25 (TERS KIRCON) BANDUNG 7564929 PT RUMAH SAKIT

PADJADJARAN PER/08/012016 RS.TRAUMA CENTRE 04/01/2016 31/12/2016

25 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

26 1500000000833 KLINIK KIMIA FARMA 43 JL. BUAH BATU 59 BANDUNG 7305019 PT KIMIA FARMA (PERSERO) TBK


01/05/2015 31/12/2015

27 1500000000553 KLINIK MITRA MULYAJL. AH NASUTION NO. 20 RT 001/014, CIPADUNG KIDUL, PANYILEUKAN, BANDUNG

7804489 MULYATI PER/05/042015 RS.TRAUMA CENTRE

01/04/2015 31/12/2015

28 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

29 7-4891479343KLINIK PRATAMA MONALISA JL. KOPO NO. 2016¬2018 BANDUNG 40233

08157120000

VONNY MONALISA SURYADI PER/33/092016

RS.TRAUMA CENTRE 23/09/2016 31/12/2017

30 1500000000704 KLINIK PRATAMA SEHATIRUKO BUMI MAS KENCANA KAV O. JL. AH NASUTION 928, CIKADUT, BANDUNG

7237337DRG YUDHIASTUTI NUNING HARINI


01/04/2015 31/12/2015

31 1500000000704 KLINIK PRATAMA SEHATI RUKO BUMI MAS KENCANA KAV O. JL. AH NASUTION 928, CIKADUT, BANDUNG

7237337 DRG YUDHIASTUTI NUNING HARINI


04/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


182 / 44607-11-201606:23:31



IKS


32 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

33 1500000000600 KLINIK PRATAMA SELAMAT JL. TERUSAN BUAH BATU NO. 227 BANDUNG 88881585 DR MAGDALIZA PER/06/042015 RS.TRAUMA

CENTRE 01/04/2015 31/12/2015

34 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 26/10/2016

35 1500000000853 KLINIK UJUNG BERUNG JL. RUMAH SAKIT NO.5 RT. 006/07, PAKEMITAN, CINAMBO, BANDUNG

91752269 DR HARIS FATAH PER/14/042015 RS.TRAUMA CENTRE

01/04/2015 31/12/2015

36 1500000000743 KLINIK UTAMA AL ISLAM JL. AWIBITUNG NO. 29-31 CICADAS BANDUNG 7208284

YAYASAN RUMAH SAKITISLAM-KSWI JAWA BARAT


37 1500000000743 KLINIK UTAMA AL ISLAMJL. AWIBITUNG NO. 29-31 CICADAS BANDUNG 7208284

YAYASAN RUMAH SAKITISLAM-KSWI JAWA BARAT


38 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

39 1500000000708 KLINIK UTAMA MEDIKA ANTAPANI

JALAN PURWAKARTA NO.3 ANTAPANI BANDUNG

081563944143

DRA HJ LENTE MELANIE PER/09/042015 RS.TRAUMA CENTRE

01/04/2015 31/12/2015

40 1500000000801 RS MATA CICENDO JL. CICENDO NO. 4 BANDUNG 4231280 KEMENKES PER/11/042015RS.TRAUMA CENTRE 01/01/2015 31/12/2015

41 1500000000801 RS MATA CICENDO JL. CICENDO NO. 4 BANDUNG 4231280 KEMENKES PER/20/012016RS.TRAUMA CENTRE 04/01/2016 31/12/2016

42 7-4697776525 RS MELINDA 2JL. DR. CIPTO NO. 1, PASIRKALIKI, CICENDO, JAWA BARAT

40112 DR ANCILLA LINNA PER/32/082016RS.TRAUMA CENTRE

14/09/2016 31/12/2016

43 1100000000014 RS PINDAD JL. GATOT SUBROTO NO.517 PAPANGGUNGAN BANDUNG


01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


183 / 44607-11-201606:23:31



IKS


44 1100000000014 RS PINDAD JL. GATOT SUBROTO NO.517 PAPANGGUNGAN BANDUNG 7322468 PER/21/012016 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

45 1100000000015 RS SARININGSIH JL. LL RE MARTADINATA NO. 9 PER/22/012016 RS.TRAUMA CENTRE 04/01/2016 31/12/2016

46 1100000000015 RS SARININGSIH JL. LL RE MARTADINATA NO. 9 PER/03/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

47 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

48 1500000001399 RS. SALAMUN JL. CIUMBELUIT NO. 203, BANDUNG, JAWA BARAT, 40142 2032090 DR. BAMBANG S.

GUNADI, SP.RAD., MARS., PER/20/ 052015 RS.TRAUMA CENTRE 01/05/2015 31/12/2015

49 1400000000159 RS. SANTO YUSUP JL. CIKUTRA NO. 7 BANDUNG 7208172PERKUMPULAN "PERHIMPUNAN SANTO BORROMEUS"


50 7-4474722653 RSGM UNPAD JL. SEKELOA SELATAN I, BANDUNG 40132 40132 UNIVERSITAS PADJADJARAN


01/09/2016 31/12/2017

51 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


01/07/2015 31/12/2015

52 1500000001934 RSKB HALMAHERA SIAGAJL.L.L.R.E.MARTADINATA NO.28, JAWA BARAT 40115 40115 4206061

PROF DR M AHMAD DJOJOSUGITO, DR, SP OT PER/24/012016

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

53 1500000000697 RSU BUNGSU JL. VETERAN NO. 6, BANDUNG 4231550DR. LILIAN MELATTIE E. NORE PER/07/042015

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

54 1500000000697 RSU BUNGSU JL. VETERAN NO. 6, BANDUNG 4231550DR. LILIAN MELATTIE E. NORE


04/01/2016 31/12/2016

55 7-2299406693 RSU HERMINA ARCAMANIK JL. 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


Periode : 01/01/2015 s/d 31/10/2016


184 / 44607-11-201606:23:31



IKS


56 7-5171029755 RSU HERMINA PASTEUR JL. DR DJUNDJUNAN NO 107 40173 ITA ROSWITA, MARS PER/34/092016 RS.TRAUMA CENTRE 18/10/2016 31/12/2017

57 1500000000460 RSUD KOTA BANDUNG JL. RUMAH SAKIT NO. 22, UJUNGBERUNG 7811794 PER/02/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

58 1500000000460 RSUD KOTA BANDUNG JL. RUMAH SAKIT NO. 22, UJUNGBERUNG 7811794 PER/26/012016 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

59 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

60 1500000001936 RSUP HASAN SADIKIN BANDUNG JL. RAYA PASTEUR NO 36, BANDUNG 40161 2034953 KEMENKES PER/27025015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

KANTOR CABANG : K01- KANTOR CABANG BEKASI KOTA


IKS


1 1400000000352 KLINIK TC AMUNA MEDIKAJL SILIWANGI KM 12 NAROGONG BT.GEBANG 32960966 TATI NURHAYATI PER/49/092015

RS.TRAUMA CENTRE 01/09/2015 31/12/2016

2 1500000000698 KLINIK TC ANNISAJL RAYA KAMPUNG BARU KEMANG RT 03/04 JATIBENING BARU PD GEDE BEKASI PER/17/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

3 1500000000698 KLINIK TC ANNISAJL RAYA KAMPUNG BARU KEMANG RT 03/04 JATIBENING BARU PD GEDE BEKASI


04/01/2016 31/12/2016

4 1500000000830 KLINIK TC CAHAYA ASYPA TAMAN NAROGONG INDAH BLOK C.18 NO 1 ALAN PER/24/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


185 / 44607-11-201606:23:31



IKS


5 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

6 1500000001938 KLINIK TC CEMPAKA MEDICAL CENTER JL SETIA MEKAR NO 3 TAMBUN 17216 8807111 DR. TJEPY F ALOWIE,

MSC, SPOK PER/34/092015 RS.TRAUMA CENTRE 01/09/2015 31/12/2016

7 1500000000699 KLINIK TC HANDAYANI MEDIKA

JL RAYA KALIMALANG NO 9 DS CIBUNTU CIBITUNG BEKASI


04/01/2016 31/12/2016

8 1500000000699 KLINIK TC HANDAYANI MEDIKA

JL RAYA KALIMALANG NO 9 DS CIBUNTU CIBITUNG BEKASI


01/05/2015 30/04/2016

9 1400000000356 KLINIK TC HARAPAN BARU JL HARAPAN BARU BARAT NO 51 8862936 PER/35/092015 RS.TRAUMA CENTRE 01/09/2015 31/12/2016

10 1500000000744 KLINIK TC MAHADINAJL RAYA SELANG JATI RT 03/03 WANAJAYACIBITUNG PER/22/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

11 1500000000744 KLINIK TC MAHADINA JL RAYA SELANG JATI RT 03/03 WANAJAYACIBITUNG


04/01/2016 31/12/2016

12 1500000000739 KLINIK TC MAHADINA MEDIKA

JL BOSHI RAYA NO 9 WANASARI CIBITUNG PER/21/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

13 1400000000359KLINIK TC MEDIKA HARMONY JL FATAHILLAH NO 1 CIKARANG BARAT 89110027 PER/51/092015

RS.TRAUMA CENTRE 01/09/2015 31/12/2016

14 1500000000913KLINIK TC MH THAMRIN BEKASI

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

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

15 1500000000913KLINIK TC MH THAMRIN BEKASI

JL HM JOYOMARTONO NO 31B BEKASI TIMUR


04/01/2016 31/12/2016

16 1400000000355 KLINIK TC MULIA MEDIKA JL KALI ABANG TENGAH NO 1 A 88987741 PER/35/092015 RS.TRAUMA CENTRE

01/09/2015 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


186 / 44607-11-201606:23:31



IKS


17 1400000000354 KLINIK TC NAYAKA 01 BEKASI JL. IR. H. JUANDA KAV. 143 RUKO NO. 9A-10 88958142 PER/37/092015 RS.TRAUMA

CENTRE 01/09/2015 31/12/2016

18 1400000000353 KLINIK TC NAYAKA 04 BEKASI

JL RAYA PERJUANGAN NO.26 TELUK PUCUNG 89132587 PER/37/092015 RS.TRAUMA

CENTRE 01/09/2015 31/12/2016

19 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

20 1500000001328 KLINIK TC SETO HASBADI 01 JL SEROJA NO 10A KA CEGER RT 06/02 HARAPAN JAYA

PER/30A/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

21 1500000001327 KLINIK TC SETO HASBADI 02 JL RAYA SULTAN AGUNG BLOK O NO 27 MEDAN SATRIA PER/30B/062015 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

22 1500000001327 KLINIK TC SETO HASBADI 02JL RAYA SULTAN AGUNG BLOK O NO 27 MEDAN SATRIA PER/30B/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

23 1500000001326 KLINIK TC SETO HASBADI 06 JL RAYA IMAM BONJOL NO 01 TELAGA ASIH CIKARANG BARAT

PER/30C/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

24 1500000001254 KLINIK TC SRITINA JL IMAM BONJOL NO 8 RT 01/01 TELAGA MURNI CIKARANG BARAT


01/06/2015 31/05/2016

25 1500000001254 KLINIK TC SRITINAJL IMAM BONJOL NO 8 RT 01/01 TELAGA MURNI CIKARANG BARAT PER/28/062015

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

26 1500000000745KLINIK TC VILA BEKASI INDAH

VILLA BEKASI INDAH JL GUNUNG DIENG RAYA BLOK B3 NO 12 TAMBUN PER/20/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

27 1400000000358 KLINIK TC WIRATAMAKOMP PLAZA METROPOLITAN BLOK A.3/8 TAMBUN SEL


01/09/2015 31/12/2016

28 1400000000357 KLINIK TC YAKESTI BEKASI JL RAYA NAROGONG KM 7 NO 45 8253516 M SYAFI'I MA'ARIF PER/35/092015 RS.TRAUMA CENTRE

01/09/2015 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


187 / 44607-11-201606:23:31



IKS


29 7-3241314323 RS ANNA MEDIKA JL RAYA PERJUANGAN NO 45 HARAPAN BARU BEKASI 17121 88882211 PT ANNA MEDIKA PER/05/052016 RS.TRAUMA

CENTRE 11/05/2016 31/12/2016

30 7-3374160073 RS KARYA MEDIKA I JL RAYA IMAM BONJOL NO 9B CIBITUNG 17530 29493400 DR YONITA SS NAINGGOLAN PER/04/042016 RS.TRAUMA

CENTRE 17/05/2016 31/12/2016

31 1500000001251 RS MULTAZAM MEDIKA PERUM JATIMULYA NO.1 TAMBUN PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

32 1500000001251 RS MULTAZAM MEDIKA PERUM JATIMULYA NO.1 TAMBUN PER/11/062016 RS.TRAUMA CENTRE

02/06/2016 31/12/2016

33 1500000001329 RS SETO HASBADI JL RAYA SEROJA NO 19 HARAPAN JAYA PER/10/062016 RS.TRAUMA CENTRE 02/06/2016 31/12/2016

34 1500000001329 RS SETO HASBADI JL RAYA SEROJA NO 19 HARAPAN JAYA PER/31/062015RS.TRAUMA CENTRE 01/06/2015 31/05/2016

35 7-4311524851 RS TAMAN HARAPAN BARU JL RAYA KALIABANG TENGAH NO.2 KALIABANG TENGAH

17121 88981055 DR.G.B.ROSELINDA SIWY PER/12/072016 RS.TRAUMA CENTRE

26/08/2016 31/12/2017

36 1400000000120 RSTC ANNA MEDIKA JL RAYA PERJUANGAN NO.45, HARAPAN BARU

88882211 PT ANNA MEDIKA PER/23/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

37 1400000000365 RSTC AWAL BROS BEKASIJL KH NOER ALI KAYURINGIN JAYA BEKASI SELATAN 8868888

DR DINI HANDAYANI MARS PER/36/092015

RS.TRAUMA CENTRE 01/09/2015 31/12/2016

38 1400000000715 RSTC BELLA JL IR H JUANDA NO 141 BEKASI 8801775 PER/59/122015RS.TRAUMA CENTRE 09/06/2016 31/12/2016

39 1500000001947 RSTC BUNDA MULIAJL IMAM BONJOL NO 80 WARUNG BONGKOK RT 008/008 SUKADANAU CIKARANG BARAT

17520 8900579DIONISIUS SAGIGATA YASIDA LAWING, ST


01/09/2015 31/12/2016

40 1400000000121 RSTC CIBITUNG MEDIKA J LRAYA BOSIH NO.117 CIBITUNG 88323444 PT ADHI PUTRA MEDIKA PER/19/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


188 / 44607-11-201606:23:31



IKS


41 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

42 1400000000121 RSTC CIBITUNG MEDIKA J LRAYA BOSIH NO.117 CIBITUNG 88323444 PT ADHI PUTRA MEDIKA PER/19/052015 RS.TRAUMA CENTRE 04/01/2016 31/12/2015

43 7-1086708933 RSTC HERMINA BEKASI JL KEMAKMURAN NO 39 MARGAJAYA BEKASI

17133 DR. ADIA SUSANTI, MM PER/61/122015 RS.TRAUMA CENTRE

22/12/2015 31/12/2016

44 7-976111831 RSTC HERMINA GALAXY JL GARDENIA RAYA BLOK BA I NO 11 GRAND GALAXY CITY BEKADI SELATAN

17141 DR. IRMA SURYANI PER/60/122015 RS.TRAUMA CENTRE

22/12/2015 31/12/2016

45 1500000001968 RSTC HERMINA GRAND WISATA

FESTIVAL BOULEVARD GRAND WISATA DSLAMBANG SARI KEC TAMBUN SELATAN BEKASI

17217 82651212 PER/55/092015 RS.TRAUMA CENTRE 01/09/2015 31/12/2016

46 1100000000020 RSTC HOSANA MEDICAJL PRAMUKA NO.12 RAWA LUMBU NAROGONG 8221570 JOHANES POSO PER/27/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

47 1100000000020 RSTC HOSANA MEDICA JL PRAMUKA NO.12 RAWA LUMBU NAROGONG

8221570 JOHANES POSO PER/27/062015 RS.TRAUMA CENTRE

04/01/2016 31/12/2015

48 1100000000020 RSTC HOSANA MEDICA JL PRAMUKA NO.12 RAWA LUMBU NAROGONG


09/02/2016 31/12/2016

49 1500000000681 RSTC KARYA MEDIKA IJL RAYA IMAM BONJOL NO 9B CIKARANG BARAT 29493400 DR NOVITA PER/01/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

50 7-976569533 RSTC PERMATA BEKASI JL LEGENDA RAYA NO 9 MUSTIKA JAYA 17155 DR. LISA LUTRISA, MARS PER/58/122015RS.TRAUMA CENTRE 22/12/2015 31/12/2016

51 1500000001817RSTC TAMAN HARAPAN BARU

JL KALI ABANG TENGAH NO 2 RT 4/23 PEJUANG MEDAN SATRIA


01/07/2015 30/06/2016

52 1500000001255 RSTC TIARA BEKASI JL RAYA BABELAN PER/09/062016 RS.TRAUMA CENTRE

02/06/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


189 / 44607-11-201606:23:31



IKS


53 1500000001255 RSTC TIARA BEKASI JL RAYA BABELAN PER/29/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

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

CV BATIK ESTETIKA INDONESIA PER/ 21/ 022015

RS.TRAUMA CENTRE 01/02/2015 31/12/2015

3 1400000000415 BP BUNDA MULIA JL SOMANTRI NO 11 RT 003/004 DS MEKAR MULYA PARUNG PANJANG

5978058 HJ UPEN SUPENTI PER/ 12/ 012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

4 1400000000415 BP BUNDA MULIA JL SOMANTRI NO 11 RT 003/004 DS MEKAR MULYA PARUNG PANJANG

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

25/01/2016 31/12/2016

5 1500000000073 BP NURDIN WAHID JL HM ASHARI NO 22 CIBINONG 87916739 YANNI MAUTIA S R PER/12/012016RS.TRAUMA CENTRE 25/01/2016 31/12/2016

6 1500000000073 BP NURDIN WAHID JL HM ASHARI NO 22 CIBINONG 87916739 YANNI MAUTIA S R PER/ 16/ 012015RS.TRAUMA CENTRE 01/01/2015 31/12/2015

7 7-1588689223 KLINIK AULIA MEDIKA JL.LANDBAW NO.01 16810 87902900 SUSINAH HARUN PER/22/012016RS.TRAUMA CENTRE

04/02/2016 31/12/2016

8 7-1588689227 KLINIK MH THAMRIN JL.RAYA PUNCAK KM 75 CIPAYUNG 16770 02518256172

YAYASAN MH THAMRIN PER/25/012016 RS.TRAUMA CENTRE

04/02/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


190 / 44607-11-201606:23:31



IKS


9 1400000000311 KLINIK 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

10 7-1670259391 KLINIK PERMATA HUSADA JL.RAYA BABAKAN MADANG NO.10 16810 87952811 DRG.WIWIK DWI ARYANI, MARS PER/24/012016 RS.TRAUMA

CENTRE 04/02/2016 31/12/2016

11 1500000001536 PUSKESMAS JASINGA JL.LET.SAYUTI JASINGA 085780041002


01/05/2015 31/12/2015

12 1500000001536 PUSKESMAS JASINGA JL.LET.SAYUTI JASINGA 085780041002


25/01/2016 31/12/2016

13 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

14 1400000000310 RS ATANG SANJAYA JL SARIJO NO 1 ATANG SANJAYA KEMANG 7532946 AURI PER/ 09/ 012015RS.TRAUMA CENTRE 01/01/2015 31/12/2015

15 1500000000314 RS BHAYANGKARA TK IV BOGOR

JALAN KAPTEN MUSLIHAT NO 18 8348987 POLRI PER/ 19/ 022015 RS.TRAUMA CENTRE

01/02/2015 31/12/2015

16 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

17 1200000000006 RS BINA HUSADA TC JL MAYOR OKING JAYAATMAJA 87911000 DR HARSONO PER/ 04/ 012015RS.TRAUMA CENTRE 01/01/2015 31/12/2015

18 1200000000006 RS BINA HUSADA TC JL MAYOR OKING JAYAATMAJA 87911000 DR HARSONO PER/01/012016RS.TRAUMA CENTRE 25/01/2016 31/12/2016

19 7-4922265007RS DR.H.MARZOEKI MAHDI BOGOR

JL DR SEMERU NO 114 161110251324024

RS DR.H.MARZOEKI MAHDI BOGOR


23/09/2016 01/07/2017

20 1500000000071 RS FAMILY MEDICAL CENTER TC

JL RAYA JAKARTA BOGOR KM 51 SUKARAJA

PT JALAMAS PUTRA REJEKI


25/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


191 / 44607-11-201606:23:31



IKS


21 1500000000071 RS FAMILY MEDICAL CENTER TC

JL RAYA JAKARTA BOGOR KM 51 SUKARAJA

PT JALAMAS PUTRA REJEKI PER/ 03/ 012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

22 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

23 1400000000284 RS KARYA BHAKTI PRATIWI JALAN RAYA DRAMAGA KM 7 8626868 YYS KARYA BHAKTI PRATIWI


25/01/2016 31/12/2016

24 1400000000284 RS KARYA BHAKTI PRATIWI JALAN RAYA DRAMAGA KM 7 8626868 YYS KARYA BHAKTI PRATIWI


01/01/2015 31/12/2015

25 7-3857634533 RS MEDIKA DRAMAGA JL. RAYA DRAMAGA KM 7,3 KEL MARGAJAYA KEC BOGOR BARAT 16111 025183089

00PT DRMAGA BINA MEDIKA PER/08/052016 RS.TRAUMA

CENTRE 20/06/2016 31/12/2016

26 1400000000713 RS MELANIA JALAN PAHLAWAN NO 91 BOGOR SELATAN 8321196 PT SPAA MEDIKA PER/09/012016RS.TRAUMA CENTRE 25/01/2016 31/12/2016

27 1400000000713 RS MELANIA JALAN PAHLAWAN NO 91 BOGOR SELATAN 8321196 PT SPAA MEDIKA PER/ 15/ 012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

28 1500000000074 RS PMI BOGOR TC JL PAJAJARAN NO 80 YAYASAN PMI PER/ 01/ 012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

29 1500000000074 RS PMI BOGOR TC JL PAJAJARAN NO 80 YAYASAN PMI PER/13/012016RS.TRAUMA CENTRE 25/01/2016 31/12/2016

30 7-3801222633 RS RUMAH SEHAT TERPADU JL RAYA PARUNG 16310YAYASAN RUMAH SEHAT TERPADU DOMPET DHUAFA

PER/09052016RS.TRAUMA CENTRE 15/06/2016 31/12/2016

31 1400000000309 RS SALAK BOGOR JL JENDRAL SUDIRMAN NO 8 8344609 KESDAM SILIWANGI PER/03/012016RS.TRAUMA CENTRE

25/01/2016 31/12/2016

32 1400000000309 RS SALAK BOGOR JL JENDRAL SUDIRMAN NO 8 8344609 KESDAM SILIWANGI PER/ 08/ 012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


192 / 44607-11-201606:23:31



IKS


33 1500000000072 RS SENTRA MEDIKA CIBINONG TC JL MAYOR OKING JAYAATMAJA 87909999 DRG HERMAN PER/ 05/ 012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

34 1500000000072 RS SENTRA MEDIKA CIBINONG TC JL MAYOR OKING JAYAATMAJA 87909999 DRG HERMAN PER/11/012016 RS.TRAUMA

CENTRE 25/01/2016 31/12/2016

35 1400000000333 RS TRIMITRA JL RAYA JAKARTA BOGOR KM 43 CIBINONG

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

25/01/2016 31/12/2016

36 1400000000333 RS TRIMITRA JL RAYA JAKARTA BOGOR KM 43 CIBINONG

8763055 DR EMA SUMARSAH PER/ 11/ 012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

37 1500000000637 RS VANIA JL SILIWANGI NO 11 KEL SUKASARI BOGORTIMUR PER/19/012016 RS.TRAUMA

CENTRE 25/01/2016 31/12/2016

38 1500000000637 RS VANIAJL SILIWANGI NO 11 KEL SUKASARI BOGORTIMUR PER/ 24/ 052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

39 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

40 1500000000075 RSD CIBINONG TC JL DESA TENGAH NO 27 CIBINONG PEMDA KAB BOGOR PER/ 02/ 012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

41 1500000000636 RSIA ANNISAJL RAYA KARANGGAN NO 2 DS PUSPASARI CITEUREUP YYS ANNISA PER/18/012016

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

42 1500000000636 RSIA ANNISAJL RAYA KARANGGAN NO 2 DS PUSPASARI CITEUREUP YYS ANNISA PER/ 23/ 052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

43 1500000001535 RSUD CIAWI BOGOR JL.RAYA PUNCAK NO.479 CIAWI08121101284


25/01/2016 31/12/2016

44 1500000001535 RSUD CIAWI BOGOR JL.RAYA PUNCAK NO.479 CIAWI 08121101284


01/05/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


193 / 44607-11-201606:23:31



IKS


45 1500000001535 RSUD CIAWI BOGOR JL.RAYA PUNCAK NO.479 CIAWI 08121101284 PER/25/042015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

46 1400000000442 RSUD KOTA BOGOR JALAN RAYA SUMERU NO 120 DR TRIWANDHA ELAN PER/ 14/ 012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

47 1400000000442 RSUD KOTA BOGOR JALAN RAYA SUMERU NO 120 DR TRIWANDHA ELAN PER/08/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

48 7-4222622853

RUMAH SAKIT PARU DR. M. GOENAWAN PARTOWIDIGDO CISARUA BOGOR

JL. RAYA PUNCAK KM 83 CISARUA KABUPATEN BOGOR

16750 02518253630

KEMENKES RI PER / 06 / 052016

RS.TRAUMA CENTRE

03/08/2016 31/12/2016

49 1500000000230RUMAH SAKIT PERTAMEDIKA SENTUL CITY

JL MH THAMRIN NO.1 SENTUL CITY BOGOR 29672977 KWEE LIANA KUMALA PER/ 20/ 022015 RS.TRAUMA CENTRE 01/02/2015 31/12/2015

50 1500000000230RUMAH SAKIT PERTAMEDIKA SENTUL CITY

JL MH THAMRIN NO.1 SENTUL CITY BOGOR 29672977 KWEE LIANA KUMALA PER/15/012016RS.TRAUMA CENTRE 25/01/2016 31/12/2016

51 1400000000414 SALSABILLA MEDICAL CENTRE

JL KSR DADI KUSMAYADI RUKO LMC NO 70CIKARET CIBINONG

87905768 DR WAHYU EKO W, SPOT PER/ 13/ 012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

52 1400000000414 SALSABILLA MEDICAL CENTRE

JL KSR DADI KUSMAYADI RUKO LMC NO 70CIKARET CIBINONG

87905768 DR WAHYU EKO W, SPOT PER/06/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

KANTOR CABANG : K03- KANTOR CABANG CIREBON


IKS


1 1400000000523KLINIK NAYAKA ERA HUSADA KASOKANDEL MAJALENGKA

JL CIREBON BANDUNG DESA/KEC KASOKANDEL

664664 PT. NAYAKA ERA HUSADA


23/08/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


194 / 44607-11-201606:23:31



IKS


2 1400000000525 KLINIK NAYAKA ERA HUSADA KOTA CIREBON

JALAN VETERAN NO.13 KEBONBARU KOTA CIREBON 8300223 PT NAYAKA ERA


3 1400000000525 KLINIK NAYAKA ERA HUSADA KOTA CIREBON

JALAN VETERAN NO.13 KEBONBARU KOTA CIREBON 8300223 PT NAYAKA ERA


4 1400000000524KLINIK NAYAKA ERA HUSADA PLUMBON CIREBON

JALAN RAYA CIREBON BANDUNG KM 11 BLOK KALONG RT.01/RW 03 DEPOK PLUMBON CIREBON

341738 PT.NAYAKA ERA HUSADA


23/08/2016 31/12/2017

5 1500000001053 KLINIK TRAUMA CENTRE AUREL

JALAN JANGGA-TRISI INDRAMAYU DR. DEDEN PER/006/042015 FFS 01/05/2015 30/04/2017

6 1500000001055 PKM ASTANAJAPURA JL. RAYA KH WAHID HASYIM KP 45181 DINAS KESEHATAN KABUPATEN CIREBON PER/007/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2017

7 1500000001076 PKM ASTANALANGGAR JL. SILIWANGI DESA ASTANALANGGAR 832059DINAS KESEHATAN KABUPATEN CIREBON PER/007/052015 FFS 01/05/2015 30/04/2017

8 1500000001077 PKM ASTAPADA JL. KIYAI AGENG TAPA DESA ASTAPADA DINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017

9 1500000001078 PKM BABAKAN JL. P.SUTAJAYA NO.40 DESA BABAKAN KP 45191

DINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017

10 1500000001079 PKM BEBER JL. P.SUDIRMAN NO.33 DESA BEBER 616028 PER/007/052015RS.TRAUMA CENTRE 01/05/2015 30/04/2017

11 1500000001080 PKM BUNDER JL. BY PASS DESA BUNDER KP 45168 PER/007/052015RS.TRAUMA CENTRE 01/05/2015 30/04/2017

12 1500000001081 PKM CIBOGOJL. RAYA KH. ZAENAL ARIFIN DESA CIBOGO NO.12


01/05/2015 30/04/2017

13 1500000001083 PKM CILEDUG JL. ALUN-ALUN NO.20 KP 45188 DESA CILEDUG

661091 DINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017


Periode : 01/01/2015 s/d 31/10/2016


195 / 44607-11-201606:23:31



IKS


14 1500000001220 PKM CIPERNA JL. DESA CIPERNA DINAS KESEHATAN KABUPATEN CIREBON PER/007/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2017

15 1500000001221 PKM CIWARINGIN JL. RAYA CIWARINGIN NO.35 DESA CIWARINGIN

DINAS KESEHATAN KABUPATEN CIREBON PER/007/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2017

16 1500000001084 PKM DUKUPUNTANG JL. IMAM BONJOL DESA CIKAHALANG KEC.DUKUPUNTANG



01/05/2015 30/04/2017

17 1500000001222 PKM GEBANG JL. RAYA GEBANG KM 21 DESA GEBANG KULON



01/05/2015 30/04/2017

18 1500000001085 PKM GEGESIK JL. RAYA GEGESIK NO. 20 DESA GEGESIK 357788 DINAS KESEHATAN KABUPATEN CIREBON PER/007/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2017

19 1500000001086 PKM GEMBONGAN JL. DESA GEMBONGANDINAS KESEHATAN KABUPATEN CIREBON PER/007/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2017

20 1500000001087 PKM GEMPOL JL. DESA GEMPOL DINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017

21 1500000001088 PKM GUNUNG JATI JL. SUNAN GUNUNG JATI NO.56 DESA MERTASINGA



01/05/2015 30/04/2017

22 1500000001089 PKM JAGAPURAJL. RAYA JAGAPURA GEGESIK KP 45164 DESA GEGESIK

DINAS KESEHATAN KABUPATEN CIREBON PER/007/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2017

23 1500000001091 PKM JEMARASJL. NYI MAS ENDANG GEULIS NO.88 DESA BANGODUA


RS.TRAUMA CENTRE 01/05/2015 30/04/2017

24 1500000001092 PKM KALIBUNTUJL. DI PANJAITAN KM 5.5 DESA KALIBUNTUKEC PABEDILAN

663363DINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017

25 1500000001093 PKM KALIWEDI JL. GI GESANG NO. 1 DESA KALIWEDI LOR 357185 DINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017


Periode : 01/01/2015 s/d 31/10/2016


196 / 44607-11-201606:23:31



IKS


26 1500000001223 PKM KAMARANG JL. JENDRAL A YANI NO.17 DESA KAMARANG KEC.GREGED 324025 DINAS KESEHATAN

KABUPATEN CIREBON PER/007/052015 RS.TRAUMA CENTRE 01/05/2015 30/04/2017

27 1500000001094 PKM KARANGSARI JL. KISABALANGKA NO.1 DESA KARANGSARI KEC.WERU


CENTRE 01/05/2015 30/04/2017

28 1500000001096 PKM KARANGSEMBUNG JL. RAYA KARANGTENGAH NO. 2 KEC.KARANGSEMBUNG



01/05/2015 30/04/2017

29 1500000001097 PKM KEDATON JL. SUNAN GUNUNGJATI DESA KAPETAKAN KEC.KAPETAKAN KP 45152



01/05/2015 30/04/2017

30 1500000001098 PKM KEDAWUNG JL. H JUANDA NO.284 KEC.KEDAWUNG 487795 DINAS KESEHATAN KABUPATEN CIREBON PER/007/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2017

31 1500000001099 PKM KEPUH JL. KI AGENG TEPAK NO. 147 DESA KEPUHDINAS KESEHATAN KABUPATEN CIREBON PER/007/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2017

32 1500000001100 PKM KLANGENAN JL. OTTO ISKANDARDINATA KEC. KLAGENAN



01/05/2015 30/04/2017

33 1500000001102 PKM KUBANGDELEG JL. RAYA KUBANGDELEG DINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017

34 1500000001103 PKM LOSARI JL. H. DULNGALIM 831604DINAS KESEHATAN KABUPATEN CIREBON PER/007/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2017

35 1500000001105 PKM LURAHJL. LURAH KEDUANAN NO. 1 KEC. PLUMBON 244505


RS.TRAUMA CENTRE 01/05/2015 30/04/2017

36 1500000001106 PKM MAYUNGJL. KI GEDE MAYUNG NO. 36 DESA MAYUNG KEC. GUNUNGJATI 45151



01/05/2015 30/04/2017

37 1500000001107 PKM MUNDU JL. RAYA LUWUNG DESA MUNDU DINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017


Periode : 01/01/2015 s/d 31/10/2016


197 / 44607-11-201606:23:31



IKS


38 1500000001108 PKM PABUARAN JL. P. SUTAJAYA NO. 192 DESA PABUARAN KP 451887


CENTRE 01/05/2015 30/04/2017

39 1500000001109 PKM PALIMANAN JL. OTTO ISKANDARDIANATA NO. 7 PALIMANAN


CENTRE 01/05/2015 30/04/2017

40 1500000001110 PKM PANGENAN JL. RAYA CIREBON LOSARI KM 17 DESA ENDAR



01/05/2015 30/04/2017

41 1500000001111 PKM PANGKALAN JL. NYI GEDE CANGKRING NO. 6 DESA PANGKALAN KEC. PLERED



01/05/2015 30/04/2017

42 1500000001112 PKM PANGURAGAN JL. NYI MAS GANDASAN DESA PANGKALAN


CENTRE 01/05/2015 30/04/2017

43 1500000001114 PKM PASALEMAN JL. RAYA PASALEMAN DESA PASALEMANDINAS KESEHATAN KABUPATEN CIREBON PER/007/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2017

44 1500000001115 PKM PLERED JL. OTTO ISKANDARDINATA NO, 40 DESA TEGALSARI



01/05/2015 30/04/2017

45 1500000001116 PKM PLUMBON JL. RAYA PLUMBON KM 12 PLUMBON DINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017

46 1500000001117 PKM SEDONG JL. KAPTEN MUSTOPA NO. 3 DESA SEDONGDINAS KESEHATAN KABUPATEN CIREBON PER/007/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2017

47 1500000001119 PKM SENDANG JL. SYECH NURJATI NO. 351 KEL. SENDANGDINAS KESEHATAN KABUPATEN CIREBON PER/007/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2017

48 1500000001120 PKM SIDAMULYA JL. SIDAMULYA NO. 375 DESA SIDAMULYADINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017

49 1500000001121 PKM SINDANGJAWA JL. NYI AGENG SERANG DESA SINDANG JAWA KEC. DUKUPUNTANG 456523209



01/05/2015 30/04/2017


Periode : 01/01/2015 s/d 31/10/2016


198 / 44607-11-201606:23:31



IKS


50 1500000001122 PKM SINDANGLAUT JL. LETJEN M.T. HARYONO DESA LEMAHABAG KULON


CENTRE 01/05/2015 30/04/2017

51 1500000001135 PKM SUMBER JL. P. KEJAKSAN NO. 49 KEL. SUMBER DINAS KESEHATAN KABUPATEN CIREBON PER/007/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2017

52 1500000001134 PKM SURANENGGALA JL. SUNAN GUNUNGJATI DESA SURANENGGALA KEC. SURANENGGALA



01/05/2015 30/04/2017

53 1500000001132 PKM SUSUKAN JL. RAYA SUSUKAN NO. 27 DESA SUSUKAN DINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017

54 1500000001131 PKM SUSUKAN LEBAK JL. LETKOL H. M. YUSUF DESA SUSUKAN LEBAK


CENTRE 01/05/2015 30/04/2017

55 1500000001130 PKM TALUNJL. P. CAKRABUANA DESA KECOMBERANAN


RS.TRAUMA CENTRE 01/05/2015 30/04/2017

56 1500000001129 PKM TEGALGUBUG JL. LAPANGAM BOLA DESA TEGALGUBUG DINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017

57 1500000001128 PKM TERSANA JL. MAYJEN SUTOYO NO. 4 DESA TERSANA KEC. PABEDILAN



01/05/2015 30/04/2017

58 1500000001127 PKM WALEDJL. DEWI SARTIKA NO. 124 DESA WALED KOTA


RS.TRAUMA CENTRE 01/05/2015 30/04/2017

59 1500000001126 PKM WANGUNHARJAJL. MOH RAMDAN DESA WANGUNHARJA KEC. JAMBLANG


RS.TRAUMA CENTRE 01/05/2015 30/04/2017

60 1500000001125 PKM WARUROYOM JL. WARUKAWUNG KEC. DEPOKDINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017

61 1500000001124 PKM WATUBELAH JL. TANGKIL GEDE NO. 5 KEL. WATUBELAH DINAS KESEHATAN KABUPATEN CIREBON


01/05/2015 30/04/2017


Periode : 01/01/2015 s/d 31/10/2016


199 / 44607-11-201606:23:31



IKS


62 1500000001123 PKM WINONG JL. RAYA WINONG BY PASS WINONG DESA WINONG


CENTRE 01/05/2015 30/04/2017

63 0900000000017 RSTC BHAYANGKARA TK. IV INDRAMAYU DS. KARIMUN LOSARANG PER/002/003201

5RS.TRAUMA CENTRE 01/01/2015 31/12/2015

64 0900000000017 RSTC BHAYANGKARA TK. IV INDRAMAYU

DS. KARIMUN LOSARANG PER/004/012016 RS.TRAUMA CENTRE

23/08/2016 31/12/2017

65 1500000000474 RSTC CIDERES JL. RAYA CIDERES-KADIPATEN NO. 180, BOJONG CIDERES

0233-661003

PER/001/0042016

RS.TRAUMA CENTRE

02/06/2016 31/03/2018

66 1500000000474 RSTC CIDERES JL. RAYA CIDERES-KADIPATEN NO. 180, BOJONG CIDERES

0233-661003 PER/003/032015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

67 0900000000018 RSTC CIREMAI JL KESAMBI NO.237 201861 TNI AD PER/001/012015RS.TRAUMA CENTRE 23/08/2016 31/12/2016

68 0900000000018 RSTC CIREMAI JL KESAMBI NO.237 201861 TNI AD PER/001/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

69 1500000000618 RSTC GUNUNG JATI JALAN KESAMBI NO.56 CIREBON 206330 PER/005/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2017

70 1500000001051 RSTC MAJALENGKA JALAN KESEHATAN NO.77 281043 PER/008/052015 FFS 01/05/2015 30/04/2017

71 0600000000001 RSTC MITRA PLUMBON JL. RAYA PLUMBON KM. 11 PLUMBON PER/009/092015RS.TRAUMA CENTRE 01/09/2015 31/12/2016

72 0900000000019 RSTC WIJAYA KUSUMAH JL.MARTADINATA NO.172 KUNINGAN 871565YAYASAN WIJAYA KUSUMAH


23/08/2016 31/12/2017

73 0900000000019 RSTC WIJAYA KUSUMAH JL.MARTADINATA NO.172 KUNINGAN 871565 YAYASAN WIJAYA KUSUMAH


01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


200 / 44607-11-201606:23:31


KANTOR CABANG : K04- KANTOR CABANG TANGERANG CIKOKOL


IKS


1 1500000001928 KLINIK AFIQAH JL. AMD CIBARENGKOK RT 01/04 DESA PEUSAR KEC. PANONGAN

29878013 DR. SAM MARGARETA PER/50/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

2 1500000001206 KLINIK ALAM INDAH JL KH HASYIM ASHARI NO 31 C TANGERANG 46708434 DRG SUGIHARTINI PER/39/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

3 1500000000988 KLINIK BETH RAPHA AGAVEINSANI

JL. MAULANA HASANUDIN GANG AMPERA 2 NO 7-8 PORIS GAGA BATU CEPER 23693773 DR. SUSAN MARGARITA PER/28/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

4 1500000000996 KLINIK BHAKTI MANDALA JL. MOH. TOHA NO. 20C PABUARAN TUMPENG KEC. KARAWACI TANGERANG 5518867

DR. H. R. HANDAYA DIPANEGARA, M.KES, SPAK


5 1500000000985 KLINIK CITRA SEJAHTERA JL. RAYA M. TOHA KM. 4 RT 02/02 KEL. PERIUK KEC. PERIUK

90329972 DR. DARSONO PER/27/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

6 1500000001016 KLINIK HANIFA MEDIKA JL. RAYA RAJEG RT 02/01 RAJEG RAJAWALI DESA RAJEG KEC. RAJEG 95847058 DR. HADI FATHUR

RAHMAN PER/35/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

7 1500000001017 KLINIK KARAWACI MEDIKAJL. IMAM BONJOL RAYA NO. 11 KEC. KARAWACI TANGERANG 55798985 AGUS JAELANI PER/36/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

8 1500000001244 KLINIK KOKITS MEDIKARUKO PLAZA PASAR BARU - BLOK B1 JL. MOH TOHA, PABUARAN TANGERANG

5520870 DR ALFI RAHMAH PER/42/062015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

9 1500000001241 KLINIK KOSAMBI INSANI MEGAH

RUKO KOSAMBI MEGAH BLOK A/7 JL RAYAPRANCIS DADAP TANGERANG

5502676 YAYASAN PARTUHA PER/43/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

10 1500000001712 KLINIK LESTARI ASIHPERUMAHAN MEDANG LESTARI BLOK C4/C5 KEC. PAGEDANGAN KAB. TANGERANG

TITIK SURYATI PER/46/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

11 1500000001205 KLINIK METTA MEDIKAJL LIO BARU NO 1 (JL BOURAQ) BATU CEPER 5522007 DRG. MARETI MIHARDJA PER/40/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

12 1500000001711 KLINIK MULIA ASIHPERUM BINONG BLOK B5 NO. 14 KEC. CURUG KAB. TANGERANG 15211 TITIK SURYATI PER/47/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


201 / 44607-11-201606:23:31



IKS


13 1500000001283 KLINIK NURBAYAN JL. METEOROLOGI, KOMP GURU MINDA KEL. TANAH TINGGI

DR. MOH. KHAERUMANSYAH PER/44/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

14 1500000001015 KLINIK PEGA CITA JL. RAYA PAKUHAJI KM. 5 PISANGAN KEPUH KEC. SEPATAN 118754 MIFTAHUL ULUM PER/34/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

15 1500000000994 KLINIK PRADHANARUKO PANORAMA NIAGA NO. 16-17. JL. HALIM PERDANA KUSUMA, JURUMUDI BARU-TANGERANG

54380703 DRG. NI PUTU ARI SUANDEWI


01/06/2015 31/12/2015

16 1500000000995 KLINIK PRASHANTIRUKO PANORAMA CIBODAS A2/7 JL. KIANSANTANG KEL. SANGIANG JAYA KEC. PERIUK TANGERANG

5525365 DRG. NI PUTU ARI SUANDEWI


01/06/2015 31/12/2015

17 1500000001204 KLINIK SABI MEDISTRA JL DANAU SENTANI NO 1 PERUMNAS TANGERANG 5911830 DR SOLAIMAN BUDIMAN PER/41/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

18 1500000000992 KLINIK SAMBA MEDIKAJL. KH. MAULANA HASANUDIN NO. 39 KEL. PORIS GAGA KEC. BATU CEPER TANGERANG

83666559DR. SEFI SAMBA TAKARIANTO PER/29/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

19 1500000000999 KLINIK SUDIMARA BARAT JL. RADEN FATAH NO.46 RT002/002 KEL. SUDIMARA BARAT KEC CILEDUG

7323207 LILLYANA LOKANANTA PER/33/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

20 1500000001133 KLINIK SUMBER ASIH I JL. RAYA SERANG KM 10,5 RT 001/001 DESA BITUNG JAYA KEC. CIKUPA

85145757 KUNADI SETIONO PER/37/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

21 1500000001158KLINIK SUMBER ASIH KELAPA DUA

JL. BOJONG NANGKA RAYA NO. 49 RT 05/01 MEDANG LESTARI,KEC. PAGEDANGAN 54213590 DR. MUWAH CHIDAH PER/38/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

22 1500000001159MAYAPADA HOSPITAL TANGERANG

JL. HONORIS RAYA KAV. 6, KOTA MODERN TANGERANG 55781888

DR. DEDI TEDJAKUSNADI, MARS PER/26/052015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

23 1500000001159MAYAPADA HOSPITAL TANGERANG

JL. HONORIS RAYA KAV. 6, KOTA MODERN TANGERANG

55781888DR. DEDI TEDJAKUSNADI, MARS


01/01/2016 31/12/2016

24 1400000000650 RS BHAKTI ASIH JL RADEN SALEH NO 10 KARANG TENGAH TANGERANG

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

01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


202 / 44607-11-201606:23:31



IKS


25 1400000000652 RS. SARI ASIH CILEDUG JL HOS COKROAMINOTO NO 38 CILEDUG 7333430PT. SARI ASIH PUTRA MANDIRI, DICKY R H PAMUNGKAS


26 1400000000652 RS. SARI ASIH CILEDUG JL HOS COKROAMINOTO NO 38 CILEDUG 7333430PT. SARI ASIH PUTRA MANDIRI, DICKY R H PAMUNGKAS


27 1400000000651 RS. SARI ASIH KARAWACI JL. IMAM BONJOL NO.38 5522794PT. SARI ASIH PUTRA MANDIRI, DICKY R H PAMUNGKAS


01/01/2016 31/12/2016

28 1400000000651 RS. SARI ASIH KARAWACI JL. IMAM BONJOL NO.38 5522794PT. SARI ASIH PUTRA MANDIRI, DICKY R H PAMUNGKAS


01/01/2015 31/12/2015

29 1400000000655 RS. SILOAM HOSPITALS LIPPO VILLAGE

JL. SILOAM NO 6 LIPPO VILLAGE TANGERANG 5460055

PT. SILOAM INTERNATIONAL HOSPITALS


30 1400000000655RS. SILOAM HOSPITALS LIPPO VILLAGE

JL. SILOAM NO 6 LIPPO VILLAGE TANGERANG 5460055

PT. SILOAM INTERNATIONAL HOSPITALS


31 1400000000653 RS. TINGKAT IV KESDAM JAYA DAAN MOGOT

JL DAAN MOGOT 59 5523551 TNI AD PER/15/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

32 1500000000465 RS. USADA INSANI JL. K.H HASYM ASHARI NO. 24 TANGERANG 55752575 PT. SURYA MITRA INSANI


01/01/2015 31/12/2015

33 1500000000465 RS. USADA INSANI JL. K.H HASYM ASHARI NO. 24 TANGERANG 55752575PT. SURYA MITRA INSANI PER/64/122015

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

34 1500000000017RSU KABUPATEN TANGERANG

JL JEND AHMAD YANI NO 9 TANGERANG 15111 5523507

PEMDA KABUPATEN TANGERANG PER/73/122015

RS.TRAUMA CENTRE 19/04/2016 31/12/2016

KANTOR CABANG : K05- KANTOR CABANG SERANG


Periode : 01/01/2015 s/d 31/10/2016


203 / 44607-11-201606:23:31



IKS


1 1500000001294 BALAI BESAR LATIHAN KERJA INDUSTRI SERANG

JL RAYA PANDEGLANG KM 3 KOTA SERANG 200160 DEP TENAGA KERJA DAN

TRANSMIGRASI PER/12/042015 RS.TRAUMA CENTRE 01/04/2015 30/03/2016

2 1500000001319 BERTHA MEDIKA JL. RAYA KARANG BOLONG NO. 23 08176838647 DR HALILI SANUSI PER/41/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

3 1500000000330 BP PERMATA HUSADA JL LETJEND SUPRAPTO NO 45 CILEGON WAWAN MULYANA PER/07/032015 RS.TRAUMA CENTRE

01/03/2015 31/12/2015

4 1500000000330 BP PERMATA HUSADA JL LETJEND SUPRAPTO NO 45 CILEGON WAWAN MULYANA PER/07/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

5 1500000001276 KLINIK ADNAN MEDIKAJL. RAYA SAWAHLUHUR KM 9 RT 01/01 KEL. SAWAHLUHUR, KASEMEN, KOTA SERANG

782537 MARDANI SJOFJAN PER/17/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

6 1500000001306 KLINIK AFINA ANYERJL RAYA ANYER KP.GUDANG ARENG RT.15/03 NO.25 ANYER

087771253335

DR.H.ACHMAD KHOMRUDIN PER/37/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

7 1500000001307 KLINIK AFINA CILEGON JL RAMBUTAN NO.12 PAGEBANGAN PER/36/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

8 1500000001274 KLINIK AL BAROKAH JL RAYA PIPITAN - PETIR KM 3 WALANTAKA

087771652567

MASITOH PER/19/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

9 1500000001298 KLINIK AL FURQON JL. RAYA LABUAN KM.2 TAROGONG08129460011 DR. FURQON HAITAMI PER/46/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

10 1500000001474 KLINIK AMAL SEHATJL. AYIP USMAN KEBAHARAN DUKUH LOPANG RT 05/01

087871603977 DR LENNY PER/071/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

11 1500000001482 KLINIK AMANDA MEDIKAJL RAYA LABUAN KM 128 KP. SAMBOYA KEC. ANYER

087771634586

BD. SITI FATIYAH PER/063/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

12 1500000001311 KLINIK AMBON ERA MEDIKA

KP. KAMAN SARI DS. LEUI LIMUS CIKANDE 087808192103

IIS ISNAWATI PER/33/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


204 / 44607-11-201606:23:31



IKS


13 1500000001313 KLINIK AMC (ASSA'ADAH MEDICAL CARE)

JL. RAYA PETIR KM. 16 DS. SUKAMENAK CIKEUSAL

085216679543

DRG. IKA SARI MUSTIKA WATI PER/31/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

14 1500000001290 KLINIK ANDE KERTA SEJAHTERA

JALAN LANUD GORDA KM 68 DS JULANG KEC CIKANDE (KAWASAN PT PARKLAND WORLD INDONESIA 2)

0818863604 TRIO BUDI AJTNIKO PER/27/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

15 1500000001277 KLINIK ANDRI MEDISTRA JL RAYA CIRUAS-SERANG KM. 9 NO.9 KELURAHAN CITEREP CIRUAS

10820940 DR ANDRI HAVYATRA LUBIS


01/06/2015 31/05/2016

16 1500000001293 KLINIK AR-ROHMAN JL.PROF.DR.IR SOETAMI KM.10 KP.CURUG TUTUL RANGKASBITUNG

5282828 DR. GHOZI PER/30/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

17 1500000001303 KLINIK AVIVA JL. RAYA BANTEN LAMA KM.5 SUKABE 087771372393 HJ VENI PER/40/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

18 1500000001299 KLINIK BHAKTI MULYA JL. AHMAD YANI PASAR MALIMPIMG087774495520 AGUS KHOMEINI PER/42/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

19 1500000001305 KLINIK BINA SEHAT JL KH FATAH HASAN KOMP RUKO SUKSES 1 NO.1 CIJAWA

0818967277

DR. A HASANUDIN PER/38/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

20 1500000001297 KLINIK BONA MEDIKA SERANG

JL. RAYA SERANG RUKO SUKMAJAYA 08128941444

DR RENITHA S TARBIN PER/047/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

21 1500000001292KLINIK BOUGENVILLE CIEKEK

JL. RAYA LABUAN KM 01 CIEKEK KEL. KARATON KEC. MAJASARI

08128155216 ARIEF PER/29/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

22 1500000001475 KLINIK BUCHORIJL. YUSUF MARTADILAGA NO. 36 BENGGALA

081218717666 DR. BUCHORI PER/070/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

23 1500000001472 KLINIK BUNDA MEDIKA JL. RAYA JAKARTA KM.5 PARUNG081291975941

SUIBAH PER/073/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

24 1500000001267 KLINIK DIFA JL RAYA LABUAN KM 12 KP CIPUTRI DS ALASWANGI KEC MENES

085780622081

DIDI MULYADI PER/24/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


205 / 44607-11-201606:23:31



IKS


25 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

26 1500000001468 KLINIK FAIQOH MEDIKA KP. PIPITAN RT 05/02 08111837672 DR. FAIQOH PER/077/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

27 1500000001455 KLINIK FATAHILLAH MEDIKA

JL. GRIYA SERDANG INDAH NO.229 SERDANG

087771301685

YYS FATAHILAH PER/060/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

28 1500000001321 KLINIK FIT MEDIKA JL RAYA MERAK KM. 7 NO. 2 GROGOL 087771376586

DR. DANANG PER/051/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

29 1500000001273 KLINIK GANDI MEDIKA CIKANDE

JL. RAYA SERANG KM.69 KP.GORDA, ASEM RT.021/03 CIKANDE

082311921355 MARLENA HARTATI PER/20/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

30 1500000001270KLINIK GANDI MEDIKA CILEGON

RUKO MEGA CILEGON JL.S.A. TIRTAYASA BLOK A-15 SIMPANG TIGA CILEGON

081234040715 MARLENA HARTATI PER/22/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

31 1500000001456 KLINIK GRIYA SEHAT GRIYA CILEGON BLOK A1 NO. 2 SERDANG 087778553595

DR. RETNO INDARINI PER/059/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

32 1500000001322 KLINIK HIMMAH HUSADA KARYA UTAMA

JL. SUNAN KALIJAGA NO.235 DRG H HABIBULLAH PER/049/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

33 1500000001471KLINIK IKHLAS MEDIKA 2 (DUA)

JL. RAYA SERANG JAKARTA KM 4 PAKUPATAN

087771305005 DR TETI ENDRIANI PER/074/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

34 1500000001291 KLINIK INSAN PRIMA RUKO CILEGON CITY SQUARE BLOK I-8081281980708

DRG LUSIANA ISKANDAR PER/28/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

35 1500000001320 KLINIK INSANIJL KOPO-CIKANDE KP. SEBE RT 16/05 DS RANCASUMUR

08561006342

DR M. YUSTIANA PER/050/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

36 1500000000331 KLINIK ISNA MEDIKA JL RAYA MERAK KM 8 NO.1 LINK KESERANGAN RAWAARUM

573756 DR ISNAYATI PER/08/032015 RS.TRAUMA CENTRE

01/03/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


206 / 44607-11-201606:23:31



IKS


37 1500000000331 KLINIK ISNA MEDIKA JL RAYA MERAK KM 8 NO.1 LINK KESERANGAN RAWAARUM 573756 DR ISNAYATI PER/08/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

38 1500000001473 KLINIK JANNAH 2 RUKO NIRWANA INDAH NO 8-9 KALODRAN 08111253421 ADE PER/072/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

39 1500000001479 KLINIK JASMINE SERANG JL. TRIP JAMAKSARI NO.93 KALIGANDU 081316277013

DR. TEJA RATRI PER/066/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

40 1500000001301 KLINIK KAGUNGAN JL KAGUNGAN NO 39 RT 02/07 LONTAR BARU

08129561414

TITIK SUHAYATI PER/44/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

41 1500000001310 KLINIK KHOIRUNNISA JL. CIRUAS PERMAI BLOK D1 NO.7 081316206264 IRA SYENTHIA DEWI PER/34/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

42 1500000001271 KLINIK KIBIN MEDIKA JL. RAYA SERANG-JAKARTA KM 71 KIBIN087781512539 TRIO BUDI JATNIKO PER/26/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

43 1500000001469 KLINIK KIMIA FARMA (A. YANI)

JL. JEND. A. YANI NO.57 0817897075

PT KIMIA FARMA APOTEK


01/06/2015 31/05/2016

44 1500000001470 KLINIK KIMIA FARMA (BENGGALA)

JL. YUSUF MARTADILAGA NO.144 08121345055

PT KIMIA FARMA APOTEK


01/06/2015 31/05/2016

45 1500000000254 KLINIK MEDIKA JL JEND AHAMD YANI NO.56 209975 DR. DIANAHAN PER/05/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

46 1500000000254 KLINIK MEDIKA JL JEND AHAMD YANI NO.56 209975 DR. DIANAHAN PER/05/022015RS.TRAUMA CENTRE 01/03/2015 31/12/2015

47 1500000001459 KLINIK MITRA MEDIKA JL RAYA SERANG KM 39 RT 01/01 CIKANDE081399090915

DR. MUHAIMIN PER/056/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

48 1500000000107 KLINIK MODERN MEDIKA CIKANDE

RUKO B6 KOMP MODERN INDUSTRI CIKANDE JL RAYA SERANG KM 68

400554 PT MODERN MEDIKA PER/03/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


207 / 44607-11-201606:23:31



IKS


49 1500000000107 KLINIK MODERN MEDIKA CIKANDE

RUKO B6 KOMP MODERN INDUSTRI CIKANDE JL RAYA SERANG KM 68 400554 PT MODERN MEDIKA PER/03/022015 RS.TRAUMA

CENTRE 01/02/2015 31/12/2015

50 1500000001304 KLINIK MODERN MEDIKA KRAGILAN

JL. RAYA SERANG KM.15 RUKO D-9 KRAGILAN

081316372239 PER/39/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

51 1500000001458 KLINIK MUCHIB'BAT KP. KEDINGDING RT 01/02 DS KIBIN KEC KIBIN

081319531937

BD. ELLA PER/057/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

52 1500000001461 KLINIK MULTAZAM JL. RAYA SERANG-JAKARTA KM.11 NO. 27 DS KESERANGAN KEC CIRUAS

087772826045

DR. IFAD PER/062/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

53 1500000001275 KLINIK MURASAKI MEDIKA KOMP. PEJATEN MAS BLOK C NO.1 17063774 DRG. WARIH ANJARI PER/18/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

54 1500000001296 KLINIK NURHIKMAT JL. FAMILY NO. 608988843424

MAS ANDIKA CAKRA PRATAMA PER/048/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

55 1500000001300 KLINIK PERMATA BUNDA PERUMAHAN GRIYA PERMATA ASRI ROHMAWATI PER/45/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

56 1500000001476 KLINIK PERMATA NABILA KOMPLEK PERMATA SERANG BLOK C NO 2 RT 01/17

087851215003

SUHARTININGSIH PER/069/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

57 1500000001312KLINIK PISANG MAS MEDIKA JL. RAYA KOPOMAJA

087772188889 AEP SAEFULLOH PER/32/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

58 1500000001266 KLINIK RAHAYU MEDIKA JL H UMAR NO. 6 TEMU PUTIH0818863064 ANGGIT VIRGIAWAN PER/25/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

59 1500000001460 KLINIK RAHMA MEDIKAJL. PASAR BARU RT 01/04 WALURAN, ANYER

087871177603

BD. MAMAH PER/055/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

60 1500000001464 KLINIK SAHABAT SEHAT JL RAYA TAKTAKAN 66 081316627405

DR. RAHMAT F PER/053/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


208 / 44607-11-201606:23:31



IKS


61 1500000001457 KLINIK SAKINAH JL KECAMATAN NO 4 KP CIPACUNG KEC. CIKEUSAL

087771791609 DR. ANIK SAKINAH PER/058/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

62 1500000001462 KLINIK SAPTA MEDIKA JL. RAYA SERANG KM. 71 KEDINDING KEC. KIBIN

081323209449 DR. ELIS SULASTRI PER/054/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

63 1500000001465 KLINIK SEHAT RABINZA JL. HARDIWINANGUN 60 RUKO GARUDA BLOK BI ¿ BII MC. TIMUR

08129622789

YENI SUTANTO PER/052/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

64 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

01/03/2015 31/12/2015

65 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

66 1500000001302 KLINIK TANTI KIRANA KP CIMINYAK KAB LEBAK081311361619 NURLAELAH PER/43/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

67 1500000001481 KLINIK TUBAGUS MEDIKA JL RAYA PALKA KM 1 (PALIMA) KEC. PABARUAN

085775665451

ELLA PER/064/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

68 1500000001308 KLINIK TUNAS MEDIKA JL. RAYA PULO AMPEL KM. 17 081395549666

H.MULYADI PER/35/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

69 1500000001477 KLINIK UTAMA MEDIKA JL. TB. SUWANDI PURI RAYA NO 1708983968988 DR. MUSLIH PER/068/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

70 1500000001454KLINIK UTAMA OTIKA BANTEN JL. SERANG PANDEGLANG KM.11 BAROS

087771648361 DR HUSEIN PER/061/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

71 1500000001272 KLINIK WIJAYA MEDIKA JL. GABUS SUKA MAJU KOPO SERANG081316224653

MARLENA HARTATI PER/21/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

72 1500000001269 PRAKTEK DR. H. SRI EKA KURNIATI

JL. RAYA BOJONEGARA KP. BAKETOR DS MARGASARI KEC. BOJONEGARA

081381562420

DR. H. SRI EKA KURNIATI


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


209 / 44607-11-201606:23:31



IKS


73 1500000001478 PRAKTEK DR. ROSTIATI JL. RAYA TAKTAKAN RT 01/12 081314868269 DR. ROSTIATI PER/067/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

74 1500000001480 PRAKTEK DR. SRI RAMAYANI PERUM PURI ANGGREK BLOK.18/4 082110400

818 DR. SRI RAMAYANI PER/065/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

75 1500000000329 RS HERMINA CIRUAS JL RAYA SERANG JAKARTA KM 9 CIRUAS 280555 HERMINA HOSPITAL GROUP


01/01/2016 31/12/2016

76 1500000000329 RS HERMINA CIRUAS JL RAYA SERANG JAKARTA KM 9 CIRUAS 280555 HERMINA HOSPITAL GROUP


01/03/2015 31/12/2015

77 7-3071694287 RS KRAKATAU MEDIKA JL SEMANG RAYA 42415 0254397456 PT KRAKATAU MEDIKA PER/03/022016 RS.TRAUMA

CENTRE 26/04/2016 31/01/2017

78 1500000000086 RS SARI ASIH SERANG JL JEND SUDIRMAN NO 38 SERANG 220022PT SARI ASIH ARIA CEMERLANG PER/01/012015

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

79 1500000000086 RS SARI ASIH SERANG JL JEND SUDIRMAN NO 38 SERANG 220022 PT SARI ASIH ARIA CEMERLANG


01/01/2016 31/12/2016

80 1500000001257 RSIA KURNIA CILEGON JL. JOMBANG MASJID NO 04 CILEGON - BANTEN

391161 PT. KURNIA SEJAHTERA PER/14/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

81 1400000000082 RSUD BANTEN JL SYECH NAWAWI AL-BANTANI 8490911 PROVINSI BANTEN PER/010/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

82 1500000000244 RSUD DR. ADJIDARMO JL IKO DJATMIKO NO.1 RANGKASBITUNG 376433 RSUD ADJIDARMO PER/04/022015RS.TRAUMA CENTRE 01/03/2015 31/12/2015

83 1500000000244 RSUD DR. ADJIDARMO JL IKO DJATMIKO NO.1 RANGKASBITUNG 376433 RSUD ADJIDARMO PER/04/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

84 1400000000320 RSUD SERANG JL RUMAH SAKIT NO.1 42111 200528 KOTA SERANG PER/02/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


210 / 44607-11-201606:23:31



IKS


85 1400000000320 RSUD SERANG JL RUMAH SAKIT NO.1 42111 200528 KOTA SERANG PER/02/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

86 1500000001256 RUMAH SAKIT KURNIA SERANG

JL. RAYA CILEGON SERANG KM 08 KRAMATWATU 232648 PT. KURNIA SEJAHTERA PER/15/06/2015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

KANTOR CABANG : K06- KANTOR CABANG SUKABUMI


IKS


1 1500000001894 BLUD RS SEKARWANGI JL. RAYA SILIWANGI NO.49 CIBADAKPER/08/TC/082015

RS.TRAUMA CENTRE 01/08/2015 31/07/2016

2 1500000001937 KLINIK BEDAH DR.EDDY JL. RA. KOSASIH NO. 218 CIAUL 43111 244046 DR. EDDY YUSWARDI PER/12/TC/082015

RS.TRAUMA CENTRE

01/09/2015 31/08/2016

3 1400000000244 KLINIK CICURUG MEDICAL CENTER

JL. RAYA SILIWANGI NO. 17 GG KORAMIL CICURUG KP NYANGKOWEK DS MEKARSARI

733767 DR. NASOKA RAMLI PER/10/TC/082015

RS.TRAUMA CENTRE

01/07/2015 30/06/2016

4 1400000000254 KLINIK GMC CIKEMBARJL PELABUHAN 2 KM 13 KP CIBODAS RT 03/04 DS KERTARAHARJA CIKEMBAR 324417 DR NASOKA RAMLI

PER/09/TC/082015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

5 1400000000295KLINIK PADJAJARAN ASSALAM JL. RAYA CIKALONGKULON NO 61A

PER/17/TC/122015

RS.TRAUMA CENTRE 29/12/2015 31/08/2016

6 1400000000296KLINIK PADJAJARAN SUKANAGARA

JL. RAYA SUKANAGARA KM 45PER/18/TC/122015

RS.TRAUMA CENTRE

29/12/2015 31/08/2016

7 1400000000313 KLINIK PERMATA MEDICAL CENTER

JL. RAYA SILIWANGI NO. 38 PARUNGKUDA 531719 PER/19/TC/122015

RS.TRAUMA CENTRE

28/12/2015 31/08/2016


Periode : 01/01/2015 s/d 31/10/2016


211 / 44607-11-201606:23:31



IKS


8 1500000001945 KLINIK RHAGASINDO JL.RAYA SIMPANG CICANTAYAN NO.1 211068 PER/13/TC/092015

RS.TRAUMA CENTRE 01/09/2015 31/08/2016

9 1400000000245 KLINIK SUKALARANG MEDICAL SERVICE

JL SUKABUMI-CIANJUR KP MANGLID RT 03/02 DS CIMANGKOK SUKALARANG 260227 DR NASOKA RAMLI PER/11/TC/0820

15RS.TRAUMA CENTRE 01/07/2015 30/06/2016

10 1500000000371 PKM BAROS DS BAROS PER/03/TC/042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

11 1500000000369 PKM BENTENG JL BENTENG KIDUL PER/03/TC/042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

12 1500000000156 PKM CIBADAK JL RAYA SEGOG KM 11 KEC CIBADAK PER/02/TC/022015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

13 1500000000360 PKM CIBEUREUM HILIR JL CIBEUREUM HILIRPER/03/TC/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

14 1500000000157 PKM CICANTAYAN JL KH DAMANHURI KM 2 KEC CICANTAYAN

PER/02/TC/022015

RS.TRAUMA CENTRE

01/02/2015 31/01/2016

15 1500000000159 PKM CICURUG JL SILIWANGI NO 113 KEC CICURUG PER/02/TC/022015

RS.TRAUMA CENTRE

01/02/2015 31/01/2016

16 1500000000160 PKM CIDAHU JL RAYA CIDAHU KM 7PER/02/TC/022015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

17 1500000000152 PKM CIKEMBAR JL PELABUHAN II KEC CIKEMBARPER/02/TC/022015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

18 1500000000362 PKM CIKUNDUL JL PROKLAMASIPER/03/TC/042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

19 1500000000155 PKM CIPARI JL RAYA CISAAT DS CISAAT KEC CICURUG PER/02/TC/022015

RS.TRAUMA CENTRE

01/02/2015 31/01/2016


Periode : 01/01/2015 s/d 31/10/2016


212 / 44607-11-201606:23:31



IKS


20 1500000000372 PKM CIPELANG JL. JEND SUDIRMAN NO. 21 PER/03/TC/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

21 1500000000368 PKM GEDONG PANJANG JL OTTO ISKANDARDINATA PER/03/TC/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

22 1500000000162 PKM GUNUNG GURUH JL PELABUHAN II PANYWEUAN DS SIRNA RESMI

PER/02/TC/022015

RS.TRAUMA CENTRE

01/02/2015 31/01/2016

23 1500000000161 PKM KADUDAMPIT JL SITUGUNUNG KM 6 KEC KADUDAMPIT PER/02/TC/022015

RS.TRAUMA CENTRE

01/02/2015 31/01/2016

24 1500000000361 PKM KARANG TENGAH JL MERBABU NO 14 GN PUYUH PER/03/TC/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

25 1500000000158 PKM KARAWANG JL SELABINTANA KM 5PER/02/TC/022015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

26 1500000000370 PKM LEMBURSITU JL. LEMBURSITU PER/03/TC/042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

27 1500000000367 PKM LIMUSNUNGGAL JL PELDA SURYANTA PER/03/TC/042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

28 1500000000365 PKM NANGGELENG JL PELDA SUYATNAPER/03/TC/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

29 1500000000364 PKM PABUARAN JL PABUARANPER/03/TC/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

30 1500000000163 PKM PARAKANSALAK JL NEGLASARI NO 3 KEC PARAKANSALAKPER/02/TC/022015

RS.TRAUMA CENTRE

01/02/2015 31/01/2016

31 1500000000149 PKM PARUNGKUDA JL RAYA SILIWANGI NO 21 KEC PARUNGKUDA

PER/02/TC/022015

RS.TRAUMA CENTRE

01/02/2015 31/01/2016


Periode : 01/01/2015 s/d 31/10/2016


213 / 44607-11-201606:23:31



IKS


32 1500000000150 PKM SEKARWANGI JL SILIWANGI RW 017 KEC CIBADAK PER/02/TC/022015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

33 1500000000358 PKM SELABATU JL. SURYAKENCANA NO. 45 PER/03/TC/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

34 1500000000373 PKM SUKABUMI JL RAYA CIAUL PER/03/TC/042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

35 1500000000363 PKM SUKAKARYA JL TEGAL WANGI PER/03/TC/042015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

36 1500000000154 PKM SUKALARANG JL LEMBUR KM 7 KEC SUKALARANG PER/02/TC/022015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

37 1500000000366 PKM TIPAR JL PEGADAIAN NO 1PER/03/TC/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

38 1500000000059 RS BETHA MEDIKA JL. RAYA CISAAT NO. 595 224128 PER/02/TC/012015

RS.TRAUMA CENTRE

01/01/2015 31/12/2015

39 1500000000059 RS BETHA MEDIKA JL. RAYA CISAAT NO. 595 224128 PER/14/TC/12/2015

RS.TRAUMA CENTRE

01/01/2016 31/12/2016

40 1400000000196 RS BHAKTI MEDICAREJL. RAYA SILIWANGI NO. 186 B, CICURUG, KAB SUKABUMI 731555 SUPRIADI SETIAWAN

PER/06/TC/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

41 1400000000196 RS BHAKTI MEDICAREJL. RAYA SILIWANGI NO. 186 B, CICURUG, KAB SUKABUMI 731555 SUPRIADI SETIAWAN

PER/03/TC/042016

RS.TRAUMA CENTRE 01/05/2016 30/04/2018

42 1400000000237 RS HERMINA SUKABUMI JL RAYA SUKARAJA SUKABUMI 6252525 DR HASMORO, MHA, MMPER/07/TC/062015

RS.TRAUMA CENTRE

01/07/2015 30/06/2016

43 1400000000237 RS HERMINA SUKABUMI JL RAYA SUKARAJA SUKABUMI 6252525 DR HASMORO, MHA, MM PER/01/TC/072016

RS.TRAUMA CENTRE

21/07/2016 30/06/2017


Periode : 01/01/2015 s/d 31/10/2016


214 / 44607-11-201606:23:31



IKS


44 1400000000531 RS KARTIKA MEDICAL CENTER JL. JEND. A. YANI NO 18A 6250902 PER/02/TC/0420

16RS.TRAUMA CENTRE 04/04/2016 30/11/2017

45 1500000000359 RS. AL MULK JL LEMBURSITU PER/04/TC/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

46 1400000000522 RS. BHAYANGKARA TK III SETUKPA

JL. AMINTA AZMALI NO. 59 229207 PER/11/TC/122014

RS.TRAUMA CENTRE

01/01/2015 31/12/2016

47 1400000000287 RSUD CIANJUR JL. RUMAH SAKIT NO.1 PER/16/TC/122015

RS.TRAUMA CENTRE

29/12/2015 31/08/2016

48 1400000000287 RSUD CIANJUR JL. RUMAH SAKIT NO.1 PER/01/TC/092016

RS.TRAUMA CENTRE 07/10/2016 31/08/2017

49 1400000000671 RSUD CIMACAN JL. RAYA CIMACAN NO. 17 CIPANAS 512465PER/15/TC/122015

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

50 1400000000671 RSUD CIMACAN JL. RAYA CIMACAN NO. 17 CIPANAS 512465 PER/13/TC/122014

RS.TRAUMA CENTRE

01/01/2015 31/12/2015

51 1500000000060 RSUD PELABUHAN RATU JL. A. YANI NO. 2 PELABUHAN RATU PER/01/TC/012015

RS.TRAUMA CENTRE

01/01/2015 31/12/2015

52 1500000000060 RSUD PELABUHAN RATU JL. A. YANI NO. 2 PELABUHAN RATUPER/20/TC/122015

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

53 1500000000515 RSUD R. SYAMSUDIN SH JL. RUMAH SAKIT NO. 1PER/05/TC/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

54 1500000000515 RSUD R. SYAMSUDIN SH JL. RUMAH SAKIT NO. 1PER/01/TC/042016

RS.TRAUMA CENTRE

04/04/2016 31/03/2017

55 1500000000428 RUMKITBAN 03.08.01 PANGRANGO

JL. PGRI NO 8 PER/04/TC/042016

RS.TRAUMA CENTRE

04/04/2016 31/03/2018


Periode : 01/01/2015 s/d 31/10/2016


215 / 44607-11-201606:23:31



IKS


56 1500000000428 RUMKITBAN 03.08.01 PANGRANGO JL. PGRI NO 8 PER/05/TC/0420

15RS.TRAUMA CENTRE 01/04/2015 31/03/2016

KANTOR CABANG : K07- KANTOR CABANG TASIKMALAYA


IKS


1 1500000001229 KLINIK PADJADJARAN KARANGPAWITAN JL RAYA KARANGPAWITAN NO. 261 0435877 PT RS PADJADJARAN PER/02/052015 RS.TRAUMA

CENTRE 04/05/2015 03/05/2016

2 1500000000772KLINIK PADJADJARAN LEUWIGOONG JL RAYA LEUWIGOONG KP PASAR KIDUL 0435877 PT RS PADJADJARAN PER/03/052015

RS.TRAUMA CENTRE 04/05/2015 03/05/2016

3 1500000000806 KLINIK PRATAMA PADJADJARAN WANARAJA

KP CIKOLE NO. 09 RT 003/004 DESA WANASARI KEC. WANARAJA

0435877 PT RS PADJADJARAN PER/05/052015 RS.TRAUMA CENTRE

04/05/2015 03/05/2016

4 10223001 PUSKESMAS JAMANIS JL. RAYA JAMANIS KEC. JAMANIS PER/23/062015 RS.TRAUMA CENTRE

01/06/2015 30/05/2016

5 7-4292261448 RSTC RSUD KOTA BANJAR JL HUSEIN KARTASASMITA NO. 5 46311 PEMKOT BANJAR PER/03/062016RS.TRAUMA CENTRE 08/08/2016 05/06/2017

6 1400000000593RUMAH SAKIT JASA KARTINI JL OTTO ISKANDARDINATA NO. 15 331808

PT. KARSA ABDI HUSADA PER/68/122015

RS.TRAUMA CENTRE 09/02/2016 31/12/2016

7 7-4691216414TC KLINIK AL YAMIN MEDICAL CENTER

JL RAYA BANDUNG TASIK KM 48 NO 8 KEC BL LIMBANGAN

44186 H YAMIN SUPRIATNA PER/09/082016RS.TRAUMA CENTRE

20/09/2016 31/12/2017

8 7-4865494643 TC KLINIK PADJAJARAN KARANGPAWITAN

JL RAYA KARANGPAWITAN NO 261 KPAGROG DS SINDANGGALIH

44182 026222448818

PT RUMAH SAKIT PADJAJARAN


20/09/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


216 / 44607-11-201606:23:31



IKS


9 7-4867949619 TC KLINIK PADJAJARAN LELES JL RAYA LELES DS LELEC KEC LELES 44119 PT RUMAH SAKIT

PADJAJARAN PER/07/082016 RS.TRAUMA CENTRE 20/09/2016 31/12/2017

10 7-4867072597 TC KLINIK PADJAJARAN LEUWIGOONG JL RAYA LEUWIGOONG KP PASAR KIDUL 44192 026246723

7PT RUMAH SAKIT PADJAJARAN PER/06/082016 RS.TRAUMA

CENTRE 20/09/2016 31/12/2017

11 7-4868117900 TC KLINIK PADJAJARAN WANARAJA

JL CIKOLE NO 8 DS WANASARI WANARAJA 44183 0262444128

PT RUMAH SAKIT PADJAJARAN


20/09/2016 31/12/2017

12 03800005 UPTD PUSKESMAS BANTAR JL. GALUNGGUNG KEL. BANTARSARI KEC. BUNGURSARI


01/06/2015 31/05/2016

13 10241501 UPTD PUSKESMAS BAYONGBONG

JL. SIMPANG BAYONGBONG NO. 183 DESA BAYONGBONG KEC. BAYONGBONG PER/29/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

14 1500000001218UPTD PUSKESMAS BOJONGGAMBIR

JL. RAYA CIAWI NO. 43 DESA BOJONGGAMBIR KEC. BOJONGGAMBIR PER/20/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

15 10242501 UPTD PUSKESMAS BUNGBULANG

JL. GARUDA-BUNGBULANG DESA BUNGBULANG KEC. BUNGBULANG


01/06/2015 31/05/2016

16 10295301 UPTD PUSKESMAS BUNGURSARI

JL. BUNGURSARI KEL. BUNGURSARI KEC. BUNGURSARI


01/06/2015 31/05/2016

17 10221001 UPTD PUSKESMAS CIAWI JL. PANUMBANGAN CIAWI PER/16/062015RS.TRAUMA CENTRE 01/06/2015 31/05/2016

18 10241201 UPTD PUSKESMAS CIBATUJL. KI HAJAR DEWANTORO NO. 10 KEC. CIBATU PER/27/052015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

19 10290801UPTD PUSKESMAS CIBEUREUM

JL. LETKOL BASIR SURYA KEL. AWIPARI KEC. CIBEUREUM


01/06/2015 31/05/2016

20 10221501 UPTD PUSKESMAS CIGALONTANG

JL. PERKANTORAN NO. 38 DESA CIGALONTANG KEC. CIGALONTANG


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


217 / 44607-11-201606:23:31



IKS


21 10293701 UPTD PUSKESMAS CIGEUREUNG

JL. CIGEUREUNG KEL. SUKAMANAH KEC. CIPEDES PER/48/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

22 10290301 UPTD PUSKESMAS CIHIDEUNG JL PASEH KEL. TUGURAJA PER/42/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

23 10241801 UPTD PUSKESMAS CIKAJANG

JL. RAYA CIKAJANG NO. 1 DESA CIKAJANG KEC. CIKAJANG


01/06/2015 31/05/2016

24 10222501 UPTD PUSKESMAS CIKATOMAS

JL. RAYA RUMAH SAKIT NO. 17 DESA GUNUNGSARI KEC. CIKATOMAS


01/06/2015 31/05/2016

25 10241601 UPTD PUSKESMAS CILAWU JL. RAYA GARUT-TASIK KM. 18 DESA CILAWU KEC. CILAWU PER/30/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

26 10294401UPTD PUSKESMAS CILEMBANG

JL. BEBEDILAN NO. 5 KEL. CILEMBANG KEC. CIHIDEUNG PER/49/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

27 10220901 UPTD PUSKESMAS CINEAM JL. YOGASWARA NO.112 DESA CINEAM KECAMATAN CINEAM


01/06/2015 31/05/2016

28 10220601 UPTD PUSKESMAS CISAYONG

JL. CISAYONG DESA CISAYONG KEC. CISAYONG


01/06/2015 31/05/2016

29 10242701 UPTD PUSKESMAS CISEWUJL. PUSWABAKTI NO. 13 DESA CISEWU KEC.CISEWU PER/36/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

30 10241701UPTD PUSKESMAS CISURUPAN

JL. RAYA CISURUPAN NO. 27 DESA CISURUPAN KEC. CISURUPAN PER/31/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

31 10240503UPTD PUSKESMAS DTP SUKARAJA

JL. RAYA WARUNG PEUTEUY DESA SUKARAJA KEC BANYURESMI


01/06/2015 31/05/2016

32 10223901 UPTD PUSKESMAS GUNUNG TANJUNG


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


218 / 44607-11-201606:23:31



IKS


33 10290401 UPTD PUSKESMAS INDIHIANG JL. PASAR INDIHIANG PER/43/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

34 1500000001069 UPTD PUSKESMAS JAMANIS TASIKMALAYA JL. RAYA JAMANIS KEC JAMANIS 420560 PER/07/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

35 10224701 UPTD PUSKESMAS JATI WARAS

JL. RAYA CIKATOMAS DESA JATI WARAS KEC. JATI WARAS


01/06/2015 31/05/2016

36 10223101 UPTD PUSKESMAS KADIPATEN

JL. RAYA CIAWI GARUT DESA KADIPATEN KECAMATAN KADIPATEN

957815 PER/09/06/2015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

37 10293601 UPTD PUSKESMAS KAHURIPAN

JL. SILIWANGI NO. 31 KEL. KAHURIPAN KEC. TAWANG PER/38/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

38 10290502UPTD PUSKESMAS KARANG ANYAR

JL. TAMBIR KARANGANYAR RT 02/05 KEL. KARANG ANYAR KEC. KAWALU PER/45/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

39 10220902 UPTD PUSKESMAS KARANGJAYA

JL. RAYA SIRNAJAYA DESA SIRNAJAYA PER/59/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

40 10222101 UPTD PUSKESMAS KARANGNUNGGAL

L. RAYA KARANGNUNGGAL NO. 12 DESA KARANGNUNGGAL KEC KARANGNINGGAL


01/06/2015 31/05/2016

41 10290501 UPTD PUSKESMAS KAWALUJL. PERINTIS KEMERDEKAAN NO. 238 KEL. URUG KEC. KAWALU PER/44/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

42 10240701 UPTD PUSKESMAS LELESJL. PRAMUKA NO. 4 DESA LELES KEC. LELES PER/25/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

43 10221401UPTD PUSKESMAS LEUWISARI

JL. LEUWISARI NO. 25 DESA ARJASARI KEC.LEUWISARI


01/06/2015 31/05/2016

44 10240901 UPTD PUSKESMAS LIMBANGAN

JL. RAYA LIMBANGAN TENGAH NO. 119 DESA LIMBANGAN TENGAH KEC. BL. LIMBANGAN


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


219 / 44607-11-201606:23:31



IKS


45 10293501 UPTD PUSKESMAS MANGKUBUMI JL. CIGANTANG RAYA KEL. MANGKUBUMI PER/47/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

46 10220701 UPTD PUSKESMAS MANONJAYA JL. TANGSI NO. 6 KEC. MANONJAYA PER/15/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

47 10221201 UPTD PUSKESMAS PAGEURAGEUNG

JL. RAYA PAGEURAGEUNG NO. 23 DESA PAGEURAGEUNG KEC. PAGEURAGEUNG


01/06/2015 31/05/2016

48 1500000001230 UPTD PUSKESMAS PAMEUNGPEUK

JL CILAUTEUREUN NO. 212 PER/34/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

49 10295001 UPTD PUSKESMAS PANGLAYUNGAN

JL. DINDING PERUM BPR KEL. PANGLAYUNGAN KEC. CIPEDES PER/50/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

50 03800001UPTD PUSKESMAS PARAKAN NYASAG

JL. LEUWIDAHU KALER KEL. PARAKAN NYASAG KEC. INDIHIANG PER/52/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

51 10294501 UPTD PUSKESMAS PURBARATU

JL. PURBARATU KEL SUKANAGARA KEC. PURBARATU


01/06/2015 31/05/2016

52 10221101 UPTD PUSKESMAS RAJAPOLAH

JL. RAYA RAJAPOLAH DUSUN CIBARANI DESA MANGGUNJAYA


01/06/2015 31/05/2016

53 1500000001225 UPTD PUSKESMAS SALOPAJL. RAYA SALOPA NO. 226 DESA MANDALAHAYU KEC. SALOPA PER/63/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

54 1500000001068 UPTD PUSKESMAS SALOPA JL. RAYA SALOPA NO. 226 PER/06/062015RS.TRAUMA CENTRE 01/06/2015 31/05/2016

55 03800004UPTD PUSKESMAS SAMBONGPARI

JL. MAYOR SL TOBING NO. 83 KEL. SAMBONGPARI KEC. MANGKUBUMI


01/06/2015 31/05/2016

56 03800103 UPTD PUSKESMAS SANGKALI

KP. SANGKALI KEL. SANGKALI KEC. SANGKALI


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


220 / 44607-11-201606:23:31



IKS


57 10223301 UPTD PUSKESMAS SARIWANGI

JL. SARIWANGI DESA JAYARATU DESA SARIWANGI 543414 PER/14/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

58 10241901 UPTD PUSKESMAS SINGAJAYA

L. RAYA SINGAJAYA DESA SINGAJAYA KEC. SINGAJAYA PER/33/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

59 10221301 UPTD PUSKESMAS SINGAPARNA

JL. PANCAWARNA NO. 07 DESA SINGAPARNA KEC. SINGAPARNA


01/06/2015 31/05/2016

60 03800003 UPTD PUSKESMAS SUKALAKSANA

JL. SUKALAKSANA KEL. SUKALAKSANA KEC. BUNGURSARI


01/06/2015 31/05/2016

61 1500000001217 UPTD PUSKESMAS SUKARAJA

JL RAYA SUKARAJA-MANGUREJA DESA SUKAPURA KEC. SUKARAJA PER/19/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

62 10292901UPTD PUSKESMAS TAMANSARI

JL. TAMANSARI KEL. SUKAHURIP KEC. TAMANSARI PER/37/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

63 1500000001227 UPTD PUSKESMAS TARAJU JL. RAYA TARAJU NO. 149 RT 06/01 DESA TARAJU KEC. TARAJU


01/06/2015 31/05/2016

64 10240401 UPTD PUSKESMAS TAROGONG

JL. SUHERMAN NO 3 KEC. TAROGONG PER/24/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

65 1500000001216 UPTD PUSKESMAS TAWANGJL. RAA KURATANUNGINGRAT NO. 08 KEL. LENGKONGSARI PER/40/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

66 1500000001216 UPTD PUSKESMAS TAWANGJL. RAA KURATANUNGINGRAT NO. 08 KEL. LENGKONGSARI PER/40/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

67 10221302UPTD PUSKESMAS TINEUWATI

JL. RAYA SINGAPARNA DESA SINGAPARNAKEC. SINGAPARNA


01/06/2015 31/05/2016

68 0380012 UPTD PUSKESMAS URUG JL. KANJENG SYEIKH ABD. MUHYI PER/56/06/2015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


221 / 44607-11-201606:23:31



IKS


69 1500000001226 UPTD PUSKESMAS URUG JL. KANJENG SYEIKH ABD. MUHYI PER/56/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

70 10221701 UPTD PUSKESMASN TARAJU JL. RAYA TARAJU NO. 149 RT 06/01 DESA TARAJU KEC. TARAJU PER/15/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

71 10290201 UPTS PUSKESMAS CIPEDES JL. MARTADINATA NO. 53 KEL CIPEDES PER/41/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

72 10241301 UPTS PUSKESMAS MALANGBONG

JL. RAYA ALUN - ALUIN TIMUR NO. 5 DESA MALANGBONG KEC. MALANGBONG


01/06/2015 31/05/2016

KANTOR CABANG : K09- KANTOR CABANG PURWAKARTA


IKS


1 1500000000758 KLINIK ANGKASA JL RAYA KALIJATI SUBANG TNI AU PER/11/042016 RS.TRAUMA CENTRE

23/08/2016 31/12/2017

2 1500000000758 KLINIK ANGKASA JL RAYA KALIJATI SUBANG TNI AU PER/15/052015RS.TRAUMA CENTRE 01/05/2015 30/04/2016

3 1500000001872 KLINIK ANNISA IJL RAYA INDUSTRI KP MARACANG BABAKAN CIKAO HJ NURUL HIDAYATI PER/12/042016

RS.TRAUMA CENTRE 23/08/2016 31/12/2017

4 1500000001872 KLINIK ANNISA IJL RAYA INDUSTRI KP MARACANG BABAKAN CIKAO

HJ NURUL HIDAYATI PER/14/042015RS.TRAUMA CENTRE

01/05/2015 30/04/2016

5 1500000000529 KLINIK AQMA CIKAMPEK JL STASIUN NO 93 CIKAMPEK KARAWANG 310524 DOKTER IFRAN HAVSON HA, MARS


01/10/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


222 / 44607-11-201606:23:31



IKS


6 1500000000529 KLINIK AQMA CIKAMPEK JL STASIUN NO 93 CIKAMPEK KARAWANG 310524 DOKTER IFRAN HAVSON HA, MARS PER/15/102015 RS.TRAUMA

CENTRE 01/10/2015 30/09/2016

7 1500000000528 KLINIK AQMA PLERED JL. ANJUN NO 96 PLERED PURWAKARTA 270830 DR. IFRAN HAVSON, HA. MARS PER/16/102015 RS.TRAUMA

CENTRE 01/10/2015 30/09/2016

8 1500000000528 KLINIK AQMA PLERED JL. ANJUN NO 96 PLERED PURWAKARTA 270830 DR. IFRAN HAVSON, HA. MARS


01/10/2016 31/12/2017

9 1500000000530 KLINIK AQMA PURWAKARTA

JL. IBRAHIM SINGADILAGA NO. 14 PURWAKARTA

200377 DR. IFRAN HAVSON PER/17/102015 RS.TRAUMA CENTRE

01/10/2015 30/09/2016

10 1500000000530 KLINIK AQMA PURWAKARTA

JL. IBRAHIM SINGADILAGA NO. 14 PURWAKARTA 200377 DR. IFRAN HAVSON PER/23/082016 RS.TRAUMA

CENTRE 01/10/2016 31/12/2017

11 1500000000542 KLINIK AQMA SUBANGJL COMPRENG NO 25 PUSAKAJAYA SUBANG 540261

DR. IFRAN HAVSON HA, MARS PER/18/102015

RS.TRAUMA CENTRE 01/10/2015 30/09/2016

12 1500000000542 KLINIK AQMA SUBANG JL COMPRENG NO 25 PUSAKAJAYA SUBANG

540261 DR. IFRAN HAVSON HA, MARS


01/10/2016 31/12/2017

13 1500000000696 KLINIK CAMPAKA JL SADANG SUBANG DS CAMPAKASARI KEC CAMPAKA

212451 DR. NATALIA INDAWATI W


01/05/2015 30/04/2016

14 1500000000696 KLINIK CAMPAKAJL SADANG SUBANG DS CAMPAKASARI KEC CAMPAKA 212451

DR. NATALIA INDAWATI W PER/07/042016

RS.TRAUMA CENTRE 23/08/2016 31/12/2017

15 1500000000769 KLINIK INSAN MADANI JL RAYA CIBOGO KM 7 SUBANG ASRIL ARSYAD DIPL RAD PER/17/052015RS.TRAUMA CENTRE 01/05/2015 30/04/2016

16 1500000000769 KLINIK INSAN MADANI JL RAYA CIBOGO KM 7 SUBANG ASRIL ARSYAD DIPL RAD PER/08/042016RS.TRAUMA CENTRE

23/08/2016 31/12/2017

17 1400000000391 KLINIK MIRACLE KOMP ANEKA JASA BLOK A2 NO. 9-10 KBI 351377 DR SUSANTO ONGKOWIDJAJA


01/10/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


223 / 44607-11-201606:23:31



IKS


18 1400000000391 KLINIK MIRACLE KOMP ANEKA JASA BLOK A2 NO. 9-10 KBI 351377 DR SUSANTO ONGKOWIDJAJA PER/19/102015 RS.TRAUMA

CENTRE 01/10/2015 30/09/2016

19 1500000000694 KLINIK MUNJUL JL IPIK GANDAMANAH NO 206 212451 DR. NATALIA INDAWATYW PER/09/042016 RS.TRAUMA

CENTRE 23/08/2016 31/12/2017

20 1500000000694 KLINIK MUNJUL JL IPIK GANDAMANAH NO 206 212451 DR. NATALIA INDAWATYW


01/05/2015 30/04/2016

21 1500000000695 KLINIK MUNJUL JAYA 2 JL PRAMUKA NO 21 DS BUNDER KEC JATILUHUR

212451 DR. NATALIA INDAWATI W


01/05/2015 30/04/2016

22 1500000000695 KLINIK MUNJUL JAYA 2 JL PRAMUKA NO 21 DS BUNDER KEC JATILUHUR 212451 DR. NATALIA INDAWATI

W PER/10/042016 RS.TRAUMA CENTRE 23/08/2016 31/12/2017

23 1500000001208 KLINIK PRAMA MEDIKA DSN JURUTILU NO. 72 RT 72/6 KEC. CIASEMDR PEPEN SOFYAN EFENDI PER/15/052016

RS.TRAUMA CENTRE 23/08/2016 31/12/2017

24 1500000001208 KLINIK PRAMA MEDIKA DSN JURUTILU NO. 72 RT 72/6 KEC. CIASEM DR PEPEN SOFYAN EFENDI


01/06/2015 31/05/2016

25 1500000001020 KLINIK RADIATIE JL. RAYA CIKOPO RT 6/3 DS CIKOPO PURWAKARTA

DR PEPEN SOFIAN EFENDI


01/06/2015 31/05/2016

26 1500000001020 KLINIK RADIATIEJL. RAYA CIKOPO RT 6/3 DS CIKOPO PURWAKARTA

DR PEPEN SOFIAN EFENDI PER/16/052016

RS.TRAUMA CENTRE 23/08/2016 31/12/2017

27 1500000001022 KLINIK WALUYA JL . RE MARTADINATA NO 60DR . PEPEN SOFIAN EFENDI PER/13/052016

RS.TRAUMA CENTRE 23/08/2016 31/12/2017

28 1500000001022 KLINIK WALUYA JL . RE MARTADINATA NO 60DR . PEPEN SOFIAN EFENDI

PER/ 20 / 052015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

29 1500000001021 KLINIK WIJAYA KUSUMAH JL. RE MARTADINATA NO. 66 DR PEPEN SOFIAN EFENDI


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


224 / 44607-11-201606:23:31



IKS


30 1500000001021 KLINIK WIJAYA KUSUMAH JL. RE MARTADINATA NO. 66 DR PEPEN SOFIAN EFENDI PER/14/052016 RS.TRAUMA

CENTRE 23/08/2016 31/12/2017

31 1400000000326 PUSKESMAS CIASEM JL. RAYA CIASEM KEC CIASEM 081320777941

DINAS KESEHATAN KAB SUBANG PER/17/08/2016 RS.TRAUMA

CENTRE 01/09/2016 31/12/2017

32 1400000000326 PUSKESMAS CIASEM JL. RAYA CIASEM KEC CIASEM 081320777941

DINAS KESEHATAN KAB SUBANG


01/09/2015 31/08/2016

33 1400000000328 PUSKESMAS CIBOGO JL RAYA CINANGSI KEC CIBOGO 08121849993



01/09/2015 31/08/2016

34 1400000000328 PUSKESMAS CIBOGO JL RAYA CINANGSI KEC CIBOGO 08121849993

DINAS KESEHATAN KAB SUBANG PER/18/08/2016 RS.TRAUMA

CENTRE 01/09/2016 31/12/2017

35 1400000000329PUSKESMAS CIPEUNDEUY SUBANG JL.RAYA PABUARAN CIPEUNDUY DINAS KESEHATAN PER/11/092015

RS.TRAUMA CENTRE 01/09/2015 31/08/2016

36 1400000000329 PUSKESMAS CIPEUNDEUY SUBANG

JL.RAYA PABUARAN CIPEUNDUY DINAS KESEHATAN PER/19/082016 RS.TRAUMA CENTRE

01/09/2016 31/12/2017

37 1400000000330 PUSKESMAS PABUARAN JL RAYA PASAR SENEN PABUARAN KEC PABUARAN

081320284083

DINAS KESEHATAN PER/12/092015 RS.TRAUMA CENTRE

01/09/2015 31/08/2016

38 1400000000330 PUSKESMAS PABUARANJL RAYA PASAR SENEN PABUARAN KEC PABUARAN

081320284083 DINAS KESEHATAN PER/20/082016

RS.TRAUMA CENTRE 01/09/2016 31/12/2017

39 PER/ 09/022015 PUSKESMAS RAWALELE JL RAYA SUBANG KALIJATI KEC DAWUAN082216333567

DINAS KESEHATAN KAB SUBANG PER/02/012016

RS.TRAUMA CENTRE 23/08/2016 31/12/2017

40 PER/ 09/022015 PUSKESMAS RAWALELE JL RAYA SUBANG KALIJATI KEC DAWUAN082216333567



01/02/2015 01/01/2016

41 1500000000404 RS BHAKTI HUSADA II PURWAKARTA

JL. RAYA SADANG -SUBANG KM 5 RT 1/1 DSCIKUMPAY KEC. CAMPAKA


23/08/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


225 / 44607-11-201606:23:31



IKS


42 1500000000404 RS BHAKTI HUSADA II PURWAKARTA

JL. RAYA SADANG -SUBANG KM 5 RT 1/1 DSCIKUMPAY KEC. CAMPAKA 8225344 PER/11/032015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

43 1500000000759 RS PANGKALAN TNI AU SURYADARMA JL RAYA KALIJATI SUBANG TNI AU SURYADARMA PER/06/042016 RS.TRAUMA

CENTRE 23/08/2016 31/12/2017

44 1500000000759 RS PANGKALAN TNI AU SURYADARMA

JL RAYA KALIJATI SUBANG TNI AU SURYADARMA PER/16/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

45 1300000000035 RS. MH THAMRIN PURWAKARTA

JL. RAYA BUNGURSARI NO. 36 SADANG 8222222DR.H. KEMAL MUHAMAD, MMR.,M.KES,AIFO


01/01/2015 31/12/2015

46 1300000000035 RS. MH THAMRIN PURWAKARTA JL. RAYA BUNGURSARI NO. 36 SADANG 8222222

DR.H. KEMAL MUHAMAD, MMR.,M.KES,AIFO


47 1400000000434 RSUD BAYU ASIH JL VETERAN NO 39 PER/20/102015RS.TRAUMA CENTRE 21/01/2016 31/10/2016

48 1400000000441 RSUD KELAS B KABUPATEN SUBANG

JL BIGJEN KATAMSO NO 37 DINAS KESEHATAN KABUPATEN SUBANG


01/10/2015 30/09/2016

49 1400000000441 RSUD KELAS B KABUPATEN SUBANG

JL BIGJEN KATAMSO NO 37 DINAS KESEHATAN KABUPATEN SUBANG


01/10/2016 31/12/2017

50 1500000001876RUMAH SAKIT KHUSUS BEDAH RAMAHADI

JL RAYA SADANG-SUBANG DESA CIWANGI-BUNGURSARI PURWAKARTA 202136 PER/18/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

51 1500000001876RUMAH SAKIT KHUSUS BEDAH RAMAHADI

JL RAYA SADANG-SUBANG DESA CIWANGI-BUNGURSARI PURWAKARTA 202136 PER/05/042016

RS.TRAUMA CENTRE 23/08/2016 31/12/2017

52 1500000000405SILOAM HOSPITALS PURWAKARTA

JL. BUNGURSARI NO 1 219168PT. BERLIAN CAHAYA INDAH

PER/ 10/032015RS.TRAUMA CENTRE

01/04/2015 31/03/2016

53 1500000000405 SILOAM HOSPITALS PURWAKARTA

JL. BUNGURSARI NO 1 219168 PT. BERLIAN CAHAYA INDAH


23/08/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


226 / 44607-11-201606:23:31



IKS


54 1400000000401 YAYASAN AQMA JL STASIUN NO 93 CIKAMPEK PER/27/082016 RS.TRAUMA CENTRE 01/10/2016 31/12/2017

55 1400000000401 YAYASAN AQMA JL STASIUN NO 93 CIKAMPEK PER/13/102015 RS.TRAUMA CENTRE 01/10/2015 30/09/2016

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 1500000001517 KLINIK GRAHA MEDIS CILAMAYA

JL RAYA CILAMAYA DESA CILAMAYA WETAN KAB KARAWANG

340202 DR H. SUNUHARDO EP, M.KES


19/06/2015 31/12/2015

3 1500000000409 KLINIK BHAKTI MEDIKA JL AHMAD YANI NO 100 DAWUAN CIKAMPEK

8862936 MUHAMMAD SAFI'I MA'ARIF ,SE


31/03/2015 31/12/2015

4 1500000000409 KLINIK BHAKTI MEDIKAJL AHMAD YANI NO 100 DAWUAN CIKAMPEK 8862936

MUHAMMAD SAFI'I MA'ARIF ,SE PER/15/2016

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

5 1500000000847 KLINIK BINA MEDIKAJL RAYA TELUK JAMBE NO 5 DESA TELUK JAMBE 641968 SUDIARTO (08121918055) PER/16/012016

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

6 1500000000847 KLINIK BINA MEDIKAJL RAYA TELUK JAMBE NO 5 DESA TELUK JAMBE

641968 SUDIARTO (08121918055) PER/30/052015RS.TRAUMA CENTRE

25/05/2015 31/12/2015

7 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 : 01/01/2015 s/d 31/10/2016


227 / 44607-11-201606:23:31



IKS


8 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

9 1500000000846 KLINIK GEMPOL JL RANGGA GEDE NO 29 GEMPOL KEL TANJUNG PURA KEC KARAWANG BARAT

0267-8453903 SUDIARTO (08121918055) PER/32/052015 RS.TRAUMA

CENTRE 25/05/2015 31/12/2015

10 1500000001515 KLINIK GRAHA MEDIS CIKAMPEK

JL A. YANI NO 51 DAWUAN TIMUR 310101 DR. HJ. DYAH PERMATA S.M.KES


19/06/2015 31/12/2015

11 1500000001515 KLINIK GRAHA MEDIS CIKAMPEK

JL A. YANI NO 51 DAWUAN TIMUR 310101 DR. HJ. DYAH PERMATA S.M.KES


12/01/2016 31/12/2016

12 1500000001516 KLINIK GRAHA MEDIS KOPEL

JL RAYA KLARI DS KLAPANUNGGAL RT 26/07 GINTUNG KERTA KLARI

DR H DYAH PERMATA SURYARINI M.KES PER/34/062015 RS.TRAUMA

CENTRE 19/06/2015 31/12/2015

13 1500000001516KLINIK GRAHA MEDIS KOPEL

JL RAYA KLARI DS KLAPANUNGGAL RT 26/07 GINTUNG KERTA KLARI

DR H DYAH PERMATA SURYARINI M.KES PER/13/012016

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

14 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

15 1500000001518 KLINIK GRAHA MEDIS KOSAMBI

JL RAYA KOSAMBI NO 23 DESA DUREN KLARI

435527 DR.H. SUNUHARDO EP, M.KES


19/06/2015 31/12/2015

16 1500000000843 KLINIK MITRA GEMPOLJL 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

17 1500000000843 KLINIK MITRA GEMPOLJL PROKLAMASI NO 15 KW 8 RT 003/005 KELTUNGGAK JATI KEC KARAWANG BARAT 483749 SUDIARTO (08121918055) PER/31/052015

RS.TRAUMA CENTRE 25/05/2015 31/12/2015

18 1500000000840 KLINIK MITRA SEHATJL KOSAMBI CURUG NO 28 DESA DUREN KEC KLARI

433930 SUDIARTO PER/28/052015RS.TRAUMA CENTRE

25/05/2015 31/12/2015

19 01019 KLINIK MITRA SEHAT JL. RAYA KOSAMBI CURUG NO 28 KARAWANG

433930 DR. YUNITA PUSPITASARI


12/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


228 / 44607-11-201606:23:31



IKS


20 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

21 1500000000463 KLINIK NAYAKA JL TUPAREV NO 334 B DAN C KARAWANG 418430 PENDI SUPENSI PER/19/032015 RS.TRAUMA CENTRE 31/03/2015 31/12/2015

22 1500000000848 KLINIK PURWA MEDIKA JL RAYA TAMELANG NO 53 DESA MEKARJAYA KEC. PURWASARI

433653 SUDIARTO (08121918055) PER/29/052015 RS.TRAUMA CENTRE

25/05/2015 31/12/2015

23 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

24 1500000001948 KLINIK SATRIA MEKAR JL PANGKALAN LOJI DESA TAMAN MEKAR KEC. PANGKALAN 41311 085624943

888 YAYAT SALEH PER/44/092015 RS.TRAUMA CENTRE 21/09/2015 31/12/2015

25 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

26 1500000000407 KLINIK YAKESTI JL RAYA KLARI RT 01/02 GINTUNG KERTA KLARI KARAWANG

432416 MUHAMMAD SAFEI'I MA'ARIF


12/01/2016 31/12/2016

27 1500000000407 KLINIK YAKESTI JL RAYA KLARI RT 01/02 GINTUNG KERTA KLARI KARAWANG

432416 MUHAMMAD SAFEI'I MA'ARIF


31/03/2015 31/12/2015

28 1500000001714 KLINIK YASMIN JL IR H JUANDA KM2 KOTA BARU RT 02/05 41311 SAFRINA DEWI PER/38/062015RS.TRAUMA CENTRE 29/06/2015 31/12/2015

29 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

30 1500000000849 LIRA MEDIKA JL SYECH QURO NO 14 PALUMBONSARI 8452555NY ANGELIAQUE ARYANTO


25/05/2015 31/12/2015

31 1500000000849 LIRA MEDIKA JL SYECH QURO NO 14 PALUMBONSARI 8452555 NY ANGELIAQUE ARYANTO


12/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


229 / 44607-11-201606:23:31



IKS


32 7-1272337870 RS BAYU KARTA JL. KERTABUMI NO 44 KARAWANG 41311 0267401818 DR WHISNU SANTOSO PER/01/012016 RS.TRAUMA

CENTRE 06/01/2016 26/10/2016

33 1500000000814 RS CITO JL ARTERI TOL KARAWANG BARAT KEC TELUK JAMBE 41312 414245 HAJI GANGGA ENDANG

HERMAWAN PER/26/052015 RS.TRAUMA CENTRE 18/05/2015 31/12/2015

34 1400000000368 RS CITRA SARI HUSADA JL RAYA KOSAMBI TELAGASARI KM 3 KLARI

437507 ADE RELAWATI PER/22/04/2015 RS.TRAUMA CENTRE

01/04/2015 31/12/2015

35 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

36 1500000001708 RS DELIMA ASIH SISMA MEDIKA

JL WIRASABA NO 54 JOHAR KEC KARAWANG TIMUR 41311 403073 PT DELIMA SISMA


37 1500000001708RS DELIMA ASIH SISMA MEDIKA

JL WIRASABA NO 54 JOHAR KEC KARAWANG TIMUR 41311 403073

PT DELIMA SISMA MEDIKA PER/37/062015

RS.TRAUMA CENTRE 29/06/2015 31/12/2015

38 1400000000349 RS ISLAM KARAWANG JL. PANGKAL PERJUANGAN KM. 2 PER/21/042015 RS.TRAUMA CENTRE

01/04/2015 31/12/2015

39 1400000000349 RS ISLAM KARAWANG JL. PANGKAL PERJUANGAN KM. 2 PER/06/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

40 1500000000408 RS IZZAJL RAYA CISELANG DESA CIKAMPEK UTARA KECAMATAN KOTA BARU 8386830

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


41 1500000000408 RS IZZAJL RAYA CISELANG DESA CIKAMPEK UTARA KECAMATAN KOTA BARU 8386830

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


42 1400000000348 RS KARYA HUSADAJL. JEND. AHMAD YANI NO. 98 CIKAMPEK KARAWANG


01/04/2015 31/12/2015

43 1400000000348 RS KARYA HUSADA JL. JEND. AHMAD YANI NO. 98 CIKAMPEK KARAWANG


12/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


230 / 44607-11-201606:23:31



IKS


44 7-1122449393 RS MANDAYA JL. ARTERI TOL KARAWANG BARAT 41312 HAJI GANGGA ENDANG PER/03/012016 RS.TRAUMA CENTRE 05/01/2016 31/12/2016

45 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

46 1400000000347 RS PURI ASIH JATISARI JL. RAYA JATISARI NO. 3 MEKARSARI JATISARI

DR AKID PER/23/04/2015 RS.TRAUMA CENTRE

01/04/2015 31/12/2015

47 7-2322882543 RS ROSELA JL. INTERCHANGE NO 3 TOL KARAWANG BARAT DS WADAS

41311 DR YESI KARYA LIANTI, MARS


02/03/2016 31/12/2016

48 06823 RSU DELIMA ASIH SISMA MEDIKA JL WIRASABA NO 54 JOHAR 403073 PER/04/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

49 7-4937973143RSUD KABUPATEN KARAWANG

JL GALUH MAS RAYA NO 1 DESA SUKAHARJA TELUK JAMBE TIMUR 41311

PEMERINTAH DAERAH KARAWANG PER/37/092016

RS.TRAUMA CENTRE 27/09/2016 31/08/2017

50 7-1277095197 RUMAH SAKIT FIKRI MEDIKA

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

05/01/2016 30/06/2016

KANTOR CABANG : K11- KANTOR CABANG CIMAHI


IKS


1 1500000001616 KLINIK CAHAYA BUNDAJL PASIR KEMIRI BLOK A NO. 2 RT01 RW18 DS CIGUGUR GIRANG KEC PARONGPONG


02/07/2016 30/06/2017

2 1500000001616 KLINIK CAHAYA BUNDA JL PASIR KEMIRI BLOK A NO. 2 RT01 RW18 DS CIGUGUR GIRANG KEC PARONGPONG


01/07/2015 01/07/2016


Periode : 01/01/2015 s/d 31/10/2016


231 / 44607-11-201606:23:31



IKS


3 1500000000232 KLINIK NAYAKA ERA HUSADA

JL. JEND. H. AMIR MACHMUD NO 477 CIBABAT CIMAHI 6640384

PT NAYAKA ERA HUSADA CABANG CIMAHI


4 1500000000232 KLINIK NAYAKA ERA HUSADA

JL. JEND. H. AMIR MACHMUD NO 477 CIBABAT CIMAHI 6640384



5 1500000000679 KLINIK NAYAKA HUSADA 02 PERUM BATUJAJAR REGENCY R6 JL RAYA BATUJAJAR KAB BANDUNG BARAT

085102712227



17/05/2016 30/04/2017

6 1500000000679 KLINIK NAYAKA HUSADA 02 PERUM BATUJAJAR REGENCY R6 JL RAYA BATUJAJAR KAB BANDUNG BARAT

085102712227



01/05/2015 30/04/2016

7 1500000000682 KLINIK NAYAKA HUSADA 06KP RANCAKUDA RT 001 RW 003 DESA CITAPEN KEC CIHAMPELAS KAB BANDUNGBARAT

085320241143



8 1500000000682 KLINIK NAYAKA HUSADA 06KP RANCAKUDA RT 001 RW 003 DESA CITAPEN KEC CIHAMPELAS KAB BANDUNGBARAT

085320241143


PER/09/05/2016RS.TRAUMA CENTRE 17/05/2016 30/04/2017

9 1500000000683 KLINIK NAYAKA HUSADA 09JL. CIHALIWUNG NO 181/10 A RT 03/10 KERTAMULYA KEC PADALARANG KAB BANDUNG BARAT

082318663331

PT NAYAKA ERA HUSADA CABANG CIMAHIA CABANG CIMAHI


01/05/2015 30/04/2016

10 1500000000683 KLINIK NAYAKA HUSADA 09JL. CIHALIWUNG NO 181/10 A RT 03/10 KERTAMULYA KEC PADALARANG KAB BANDUNG BARAT

082318663331

PT NAYAKA ERA HUSADA CABANG CIMAHIA CABANG CIMAHI


17/05/2016 30/04/2017

11 1500000000678 KLINIK NAYAKA HUSADA03JL. BAROS RT 001 RW 004 KEL LEUWIGAJAHKEC CIMAHI SELATAN

085100792646



12 1500000000678 KLINIK NAYAKA HUSADA03 JL. BAROS RT 001 RW 004 KEL LEUWIGAJAHKEC CIMAHI SELATAN

085100792646



13 1500000001615KLINIK PADJADJARAN RENDE

JL RAYA RENDE KEC CIKALONGWETANDR WENDY FREELY NUGRAHA


02/07/2016 30/06/2017

14 1500000001615 KLINIK PADJADJARAN RENDE

JL RAYA RENDE KEC CIKALONGWETAN DR WENDY FREELY NUGRAHA


01/07/2015 01/07/2016


Periode : 01/01/2015 s/d 31/10/2016


232 / 44607-11-201606:23:31



IKS


15 1500000000684 KLINIK PRATAMA AL-IKHLAS 1

JL. LETKOL GA MANULANG NO 141 RT 02 RW 02 PADALARANG 6806575 ANNEU FEURYTA PER/63/042015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016


JL. LETKOL GA MANULANG NO 141 RT 02 RW 02 PADALARANG 6806575 ANNEU FEURYTA PER/11/052016 RS.TRAUMA

CENTRE 23/05/2016 30/04/2017


JL. JEND AMIR MACHMUD NO 95 KOMP BUMI INDAH H-7 RT 006 RW 020 KEL CIBEUREUM KEC CIMAHI SELATAN

6123955 ANNEU FEURYTA PER/64/042015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


JL. JEND AMIR MACHMUD NO 95 KOMP BUMI INDAH H-7 RT 006 RW 020 KEL CIBEUREUM KEC CIMAHI SELATAN

6123955 ANNEU FEURYTA PER/12/052016 RS.TRAUMA CENTRE

23/05/2016 30/04/2017

19 1500000001930 KLINIK PRATAMA RAHARDJA

JL RAYA PURWAKARTA NO. 332 TAGOG APU PADALARANG 40391 081321355

812ENDANG HARTATI AM.KEP PER/15/062016 RS.TRAUMA

CENTRE 01/07/2016 30/06/2017

20 1500000001930KLINIK PRATAMA RAHARDJA

JL RAYA PURWAKARTA NO. 332 TAGOG APU PADALARANG 40391

081321355812

ENDANG HARTATI AM.KEP PER/72/082015

RS.TRAUMA CENTRE 03/08/2015 30/06/2016

21 1500000000233 KLINIK PRATAMA SEHAT BUDI LUHUR

JL. KERKOF NO 32 CIMAHI SELATAN 6674146 KLINIK SEHAT BUDI LUHUR


22/04/2016 28/02/2017

22 1500000000233 KLINIK PRATAMA SEHAT BUDI LUHUR

JL. KERKOF NO 32 CIMAHI SELATAN 6674146 KLINIK SEHAT BUDI LUHUR


01/03/2015 29/02/2016

23 1500000000234 KLINIK WIJAYA MEDIKA JL. RAYA CIBURUY NO 684 PADALARANG 6806125 KLINIK WIJAYA MEDIKA PER/04/022015RS.TRAUMA CENTRE 01/03/2015 29/02/2016

24 1500000000234 KLINIK WIJAYA MEDIKA JL. RAYA CIBURUY NO 684 PADALARANG 6806125 KLINIK WIJAYA MEDIKA PER/03/022016RS.TRAUMA CENTRE 22/04/2016 28/02/2017

25 1100000000027 RS DUSTIRA JL. RUMAH SAKIT NO 1 CIMAHI 6633967 PER/16/062016RS.TRAUMA CENTRE

01/07/2016 30/06/2017

26 1100000000027 RS DUSTIRA JL. RUMAH SAKIT NO 1 CIMAHI 6633967 PER/70/072015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


233 / 44607-11-201606:23:31



IKS


27 7-4587989417 RS JIWA PROVINSI JAWA BARAT

JALAN KOLONEL MASTURI KM 7 CISARUA BANDUNG BARAT 40551 222700260 PEMERINTAH PER/20/092016 RS.TRAUMA

CENTRE 01/09/2016 31/08/2017

28 1400000000224 RSU AVISENA JL. MELONG NO 170 BLOK CIKENDAL 6000830 PER/71/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

29 1400000000224 RSU AVISENA JL. MELONG NO 170 BLOK CIKENDAL 6000830 PER/13/052016 RS.TRAUMA CENTRE

01/06/2016 31/05/2017

30 1400000000225 RSUD CIBABAT CIMAHI JL. AMIR MAHMUD NO 140 CIMAHI 6652025 PER/68/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

31 1400000000225 RSUD CIBABAT CIMAHI JL. AMIR MAHMUD NO 140 CIMAHI 6652025 PER/14/052016 RS.TRAUMA CENTRE 01/06/2016 31/05/2017

KANTOR CABANG : K12- KANTOR CABANG SUMEDANG


IKS


1 1500000000508BALAI PENGOBATAN ELTIGIP

JL. PARAKAN MUNCANG , SINDANGPAKUAN, CIMANGGUNG

082116018157 ENDANG WALSUM PER/21/032015

RS.TRAUMA CENTRE 01/03/2015 31/12/2015

2 1500000000481KLINIK AFIATI BOJONGSOANG JL. RAYA BOJONGSOANG NO. 98 95547889

DR. AMETA PRIMASARI, DRG, MKES, MDSC PER/08/032015 FFS 01/03/2015 31/12/2015

3 1500000000491KLINIK AFIATI CICALENGKA

JL. RAYA BARAT NO.157, CICALENGKA 91192060DR.AMETA PRIMASARI, DRG, MKES, MDSC.

PER/09/032015 FFS 01/03/2015 31/12/2015

4 1500000000490 KLINIK AFIATI SOREANG JL. RAYA SOREANG BANJARAN NO.298 5892159 DR. AMETA PRIMASARI, DRG, MKES, MDSC

PER/10/032015 FFS 01/03/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


234 / 44607-11-201606:23:31



IKS


5 1500000000499 KLINIK CAHAYA QALBU JL. RAYA LASWI NO.480 CIKOPO, CIPARAY 85963355 DR HERVI NURYANIA MEGA REZA PER/13/032016 RS.TRAUMA

CENTRE 11/05/2016 01/03/2017

6 1500000000499 KLINIK CAHAYA QALBU JL. RAYA LASWI NO.480 CIKOPO, CIPARAY 85963355 DR HERVI NURYANIA MEGA REZA PER/15/032015 FFS 01/03/2015 31/12/2015

7 1500000000485 KLINIK IBNU SINA JL. RANCAEKEK - MAJALAYA SOLOKANJERUK

081395373337

DR.H AYI KURNIAWAN PER/19/032015 FFS 01/03/2015 31/12/2015

8 1500000000484 KLINIK KELUARGA SEHAT JL GADING TUTUKA 1 BLOK S 1 NO 5 SOREANG

85873559 BAMBANG TRIYONO PER/18/032015 FFS 01/03/2015 31/12/2015

9 1500000000521 KLINIK KESEHATAN KERJA (BKKM)

JL. RAYA RANCAEKEK KM.27 NO.612, NANJUNGMEKAR, RANCAEKEK

081320009434 PEMERINTAH PROPINSI PER/14/032015 RS.TRAUMA

CENTRE 01/03/2015 31/12/2015

10 1500000000506 KLINIK MARLINAJL. MANIRANCAN NO.226 B, DS. MAJASETRA, MAJALAYA

085722699969 HJ. ERLIN TATI PER/11/032015

RS.TRAUMA CENTRE 01/03/2015 31/12/2015

11 1500000000482 KLINIK MEDIKA PRATAMA II

JL. RAYA BANDUNG GARUT NO.24 BOJONGLOA, RANCAEKEK

7537511 LULU FOTUANA PER/15/032016 RS.TRAUMA CENTRE

11/05/2016 01/03/2017

12 1500000000482 KLINIK MEDIKA PRATAMA II

JL. RAYA BANDUNG GARUT NO.24 BOJONGLOA, RANCAEKEK

7537511 LULU FOTUANA PER/12/032015 FFS 01/03/2015 31/12/2015

13 1500000000483KLINIK MEDIKA PRATAMA III

JL. RAYA BANJARAN NO.564, BOJONGMANGGU, PAMEUNGPEUK 7537511 LULU FOTUANA PER/16/032016

RS.TRAUMA CENTRE 11/05/2016 01/03/2017

14 1500000000483KLINIK MEDIKA PRATAMA III

JL. RAYA BANJARAN NO.564, BOJONGMANGGU, PAMEUNGPEUK 7537511 LULU FOTUANA PER/13/032015 FFS 01/03/2015 31/12/2015

15 1500000000489 KLINIK NAYAKA HUSADA 05JL. MOH. TOHA PALASARI , DAYEUH KOLOT

085106398668

PT. NAYAKA ERA HUSADA


11/05/2016 01/03/2017

16 1500000000489 KLINIK NAYAKA HUSADA 05 JL. MOH. TOHA PALASARI , DAYEUH KOLOT

085106398668


PER/04/032015 FFS 01/03/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


235 / 44607-11-201606:23:31



IKS


17 1500000000488 KLINIK NAYAKA HUSADA 07 JL. BALEKAMBANG SUKAMAJU MAJALAYA 082318663334

PT. NAYAKA ERA HUSADA PER/05/032015 FFS 01/03/2015 31/12/2015

18 1500000000488 KLINIK NAYAKA HUSADA 07 JL. BALEKAMBANG SUKAMAJU MAJALAYA 082318663334

PT. NAYAKA ERA HUSADA PER/12/032016 RS.TRAUMA

CENTRE 11/05/2016 01/03/2017

19 1500000000487 KLINIK NAYAKA HUSADA 08 KP. KAWUNGSARI 324 BALEENDAH 082318663331


PER/06/032015 REIMBURSE 02/03/2015 31/12/2015

20 1500000000487 KLINIK NAYAKA HUSADA 08 KP. KAWUNGSARI 324 BALEENDAH 082318663331


PER/06/032015 FFS 02/03/2015 31/12/2015

21 1500000000511 KLINIK PADJADJARAN JL. RAYA BANDUNG SUMEDANG KM.21, JATINANGOR

083820435877

DR. REAGEN VINCENT OKTAVIAN MARCELINO PANTOUW


22 1500000000511 KLINIK PADJADJARANJL. RAYA BANDUNG SUMEDANG KM.21, JATINANGOR

083820435877

DR. REAGEN VINCENT OKTAVIAN MARCELINO PANTOUW


23 7-4415954083 KLINIK PRATAMA AMALIA JL.GEDEBAGE SELATAN NO 8 40294 IKA MUSTIKA KLISNA PER/18/082016 RS.TRAUMA CENTRE

22/08/2016 31/12/2016

24 1500000000486 KLINIK PRATAMA DR.E. ATJEP LESMANA

JL. RAYA DAYEUHKOLOT NO.335 CITEUREUP, DAYEUHKOLOT

85963355 DR. E ATJEP LESMANA PER/06/032016 RS.TRAUMA CENTRE

22/08/2016 31/12/2016

25 1500000000486KLINIK PRATAMA DR.E. ATJEP LESMANA

JL. RAYA DAYEUHKOLOT NO.335 CITEUREUP, DAYEUHKOLOT 85963355 DR. E ATJEP LESMANA PER/16/032015 FFS 01/03/2015 31/12/2015

26 7-4626032593KLINIK PRATAMA PANASIA DR.E.ATJEP LESMANA JL.M TOHA L.6.8 40238 DR E ATJEP LESMANA 7-4626032593

RS.TRAUMA CENTRE 05/09/2016 31/12/2016

27 1500000000492 KLINIK RATNASARI SEHATJL. SOREANG BANJARAN, CILUNCAT, CANGKUANG

08120605293

DR. RATNA SARIHARYANTI

PER/17/032015 FFS 01/03/2015 31/12/2015

28 1500000000492 KLINIK RATNASARI SEHAT JL. SOREANG BANJARAN, CILUNCAT, CANGKUANG

08120605293

DR. RATNA SARIHARYANTI


11/05/2016 01/03/2017


Periode : 01/01/2015 s/d 31/10/2016


236 / 44607-11-201606:23:31



IKS


29 1500000000510 KLINIK WASILAH SEHAT JL. LASWI CIPARAY NO.817, CIPARAY 5950916 DR. H. KOSIM. SYARIF MKM PER/07/032015 RS.TRAUMA

CENTRE 01/03/2015 31/12/2015

30 0900000000038 RS AMC (TRAUMA CENTRE) JL. RAYA CILEUNYI RANCAEKEK 7781630 PT. ANISSA EKA UTAMA PER/07/012016 RS.TRAUMA CENTRE 11/05/2016 01/01/2017

31 0900000000038 RS AMC (TRAUMA CENTRE) JL. RAYA CILEUNYI RANCAEKEK 7781630 PT. ANISSA EKA UTAMA PER/01/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

32 1300000000042RS BHAYANGKARA BANDUNG (TRAUMA CENTER)

5229544 POLDA JABAR PER/03/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

33 1300000000042RS BHAYANGKARA BANDUNG (TRAUMA CENTER)

5229544 POLDA JABAR PER/03/012015 RS.TRAUMA CENTRE 20/09/2016 31/12/2016

34 1500000000135 RSU PAKUWON JL RD DEWI SARTIKA NO.17 210931 PER/02/012015RS.TRAUMA CENTRE 01/01/2015 31/12/2015

35 1500000000135 RSU PAKUWON JL RD DEWI SARTIKA NO.17 210931 PER/02/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

36 1500000000505 RSUD KABUPATEN SUMEDANG

JL. P GEUSAN ULUN NO.41 7217744 PEMDA JAWA BARAT PER/09/012016 RS.TRAUMA CENTRE

19/04/2016 31/12/2016

37 1500000000505RSUD KABUPATEN SUMEDANG JL. P GEUSAN ULUN NO.41 7217744 PEMDA JAWA BARAT PER/20/032015

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

38 1500000001175RUMAH SAKIT UMUM BINA SEHAT JL. RAYA DAYEUH KOLOT NO.325 5207963

DR.H GUNTUR ALAMSYAH, MARS PER/17/052016

RS.TRAUMA CENTRE 15/06/2016 01/05/2017

39 1500000001175RUMAH SAKIT UMUM BINA SEHAT

JL. RAYA DAYEUH KOLOT NO.325 5207963DR.H GUNTUR ALAMSYAH, MARS


01/05/2015 31/12/2015

KANTOR CABANG : K13- KANTOR CABANG TANGERANG CIKUPA


Periode : 01/01/2015 s/d 31/10/2016


237 / 44607-11-201606:23:31



IKS


1 1400000000556 CIPUTRA HOSPITAL JL CITRA RAYA BOULEVARD BLOK V.00/08 SEK. 3.4 TANGERANG 59405555 CIPUTRA PKS/26/122015 RS.TRAUMA

CENTRE 30/12/2015 31/12/2016

2 1500000001507 KLINIK BHAKTI MULYA KRONJO

JL.RAYA KRONJO NO.6 DESA PASILIAN KRONJO DR.A GHOFIR PER/ PKS/ 14 /

062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

3 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

4 1500000001506 KLINIK BKKM BANTEN JL RAYA SERANG KM.31 SUMUR BANDUNG JAYANTI

DR.H.A DRAJAT A.P MKES

PER/ PKS/ 16 / 062015

RS.TRAUMA CENTRE

01/06/2015 31/12/2015

5 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

6 1500000001513 KLINIK CITRA INSANIMARDI GRAS RUKO KF02/05 CITRA RAYA CIKUPA DR SABRI

PER/ PKS/ 15 / 062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

7 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

8 1500000001314 KLINIK MILENIA SEJAHTERA 1 TIGARAKSA

JL MILENIUM RAYA 1A /A11 18-19 TIGARAKSA

29006869 PER / TC / 11 / 062015

RS.TRAUMA CENTRE

01/06/2015 31/12/2015

9 1500000001314KLINIK 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

10 1500000001309KLINIK MILENIA SEJAHTERA 2 BALARAJA

RUKO ULITMATE BLOK A1-2 JL RAYA SERANG KM24 BALARAJA 29015571

PER / TC / 12 /062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

11 1500000001309KLINIK MILENIA SEJAHTERA 2 BALARAJA

RUKO ULITMATE BLOK A1-2 JL RAYA SERANG KM24 BALARAJA

29015571 PKS/29/122015RS.TRAUMA CENTRE

11/01/2016 31/12/2016

12 1500000001512 KLINIK MULYA RAHAYU JL. PLP LEGOK ASEM NO.124 LEGOK HJ SRI LIS RAHAYU PKS/13/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


238 / 44607-11-201606:23:31



IKS


13 1500000001512 KLINIK MULYA RAHAYU JL. PLP LEGOK ASEM NO.124 LEGOK HJ SRI LIS RAHAYU PKS/30/122015 RS.TRAUMA CENTRE 11/01/2016 31/12/2016

14 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

15 1500000001508 KLINIK PRIMA MEDIKA JL. RAYA SERANG KM.14,8 KOMP RUKO B/16 CIKUPA

MUSAFAH PER/ PKS/ 17 / 062015

RS.TRAUMA CENTRE

01/06/2015 31/12/2015

16 1500000001510 KLINIK PRIMA SENTUL JL. RAYA SERANG KM.24 A/11 SENTUL BALARAJA

MUSAFAH PER/ PKS/ 18 / 062015

RS.TRAUMA CENTRE

01/06/2015 31/12/2015

17 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

18 1500000001504KLINIK UMUM & BERSALIN YULISATI JL. RAYA SERANG KM 36 JAYANTI 10/03 DR. MAWARDI LUBIS

PER/ PKS/ 19 / 062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

19 1500000001504 KLINIK UMUM & BERSALIN YULISATI

JL. RAYA SERANG KM 36 JAYANTI 10/03 DR. MAWARDI LUBIS PKS/36/122015 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

20 1500000001295 RS IBU DAN ANAK KELUARGA KITA

JL RAYA PLP CURUG NO.8 KM.8 CURUG PER/TC/10/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

21 1500000001295RS IBU DAN ANAK KELUARGA KITA JL RAYA PLP CURUG NO.8 KM.8 CURUG PER/13/052016

RS.TRAUMA CENTRE 22/09/2016 31/05/2017

22 1400000000665 RSUD BALARAJAJL.RAYA RUMAH SAKIT NO.88 DS.TOBAT KEC. BALARAJA KAB.TANGERANG 26327666 KAB. TANGERANG PKS/27/122015

RS.TRAUMA CENTRE 07/06/2016 31/12/2016

23 1400000000665 RSUD BALARAJAJL.RAYA RUMAH SAKIT NO.88 DS.TOBAT KEC. BALARAJA KAB.TANGERANG

26327666 KAB. TANGERANG PKS/27/122015RS.TRAUMA CENTRE

30/12/2015 31/12/2015

24 7-3790866831 RUMAH SAKIT HERMINA BITUNG

JALAN RAYA SERANG KM 10 CURUG 15810 59497525 DR SRI DIANA GINTING SUKA, MARS


20/07/2016 31/05/2017


Periode : 01/01/2015 s/d 31/10/2016


239 / 44607-11-201606:23:31



IKS


25 7-4547219093 RUMAH SAKIT IBU & ANAK SELARAS

JL RAYA SERANG KM 18,5 DS BOJONG CIKUPA 15710 59401277 DR. EVIE KUSMIATI PER/16/082016 RS.TRAUMA

CENTRE 29/08/2016 21/08/2017

26 1500000000734 RUMAH SAKIT MULIA INSANI

JL.RAYA SERANG KM 16.8 SUKAMULYA CIKUPA 15710 5962790 DR.NINDYAKUSUMA

KORATIWIDA,MARS PER/07/042016 RS.TRAUMA CENTRE 07/06/2016 31/03/2017

27 1500000000734 RUMAH SAKIT MULIA INSANI

JL.RAYA SERANG KM 16.8 SUKAMULYA CIKUPA 15710

5962790 DR.NINDYAKUSUMA KORATIWIDA,MARS

PKS / 05 / 052015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

KANTOR CABANG : K14- KANTOR CABANG BEKASI CIKARANG


IKS


1 1400000000407 KLINIK ANNISA IIJL. RAYA CIBARUSAH RUKO POIN, NO.31-R ,DESA SUKARESMI, KEC. CIKARANG SELATAN, KABUPATEN BEKASI

8976189 PT ANNISA MITRA HUSADA


31/10/2016 31/12/2017

2 1400000000407 KLINIK ANNISA IIJL. RAYA CIBARUSAH RUKO POIN, NO.31-R ,DESA SUKARESMI, KEC. CIKARANG SELATAN, KABUPATEN BEKASI



01/10/2015 30/09/2016

3 00533 KLINIK ANNISA III JL RUKO SENTRA CIKARANG BLOK A NO 5 89909010 PER/42/092015RS.TRAUMA CENTRE 22/08/2016 30/09/2016

4 1400000000406 KLINIK ANNISA IVJL.CIBARUSAH RAYA, NO.69, DS SERANG BARU, SERANG ,KABUPATEN BEKASI 89954434

PT ANNISA MITRA HUSADA PER/50/2015

RS.TRAUMA CENTRE 01/10/2015 30/09/2016

5 1400000000406 KLINIK ANNISA IVJL.CIBARUSAH RAYA, NO.69, DS SERANG BARU, SERANG ,KABUPATEN BEKASI

89954434PT ANNISA MITRA HUSADA


31/10/2016 31/12/2017

6 1500000001951 KLINIK ANNISAIIIJL. NIAGA RAYA, RUKO GOLDEN BOULEVARD BLOK CC 5 NO 12 SENTRA INDUSTRI JABABEKA II CIKARANG



31/10/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


240 / 44607-11-201606:23:31



IKS


7 1500000001951 KLINIK ANNISAIIIJL. NIAGA RAYA, RUKO GOLDEN BOULEVARD BLOK CC 5 NO 12 SENTRA INDUSTRI JABABEKA II CIKARANG

8976189 PT ANNISA MITRA HUSADA PER/42/092015 RS.TRAUMA

CENTRE 01/10/2015 30/09/2016

8 1500000001324 KLINIK AS-SHOFWAN JL. KEDUNG WARINGIN,KEC KEDUNG WARINGIN, KABUPATEN BEKASI 89140813 PT AS-SHOFWAN

TUNGGAL MANDIRINOMOR:PER / 20 / 062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

9 1500000001324 KLINIK AS-SHOFWAN JL. KEDUNG WARINGIN,KEC KEDUNG WARINGIN, KABUPATEN BEKASI

89140813 PT AS-SHOFWAN TUNGGAL MANDIRI


19/08/2016 30/06/2017

10 1500000001323 KLINIK AS-SYIFAJL. RAYA INDUSTRI NO.3A,KP.SEMPU GARDU, RT 04/02,DESA PASIR GOMBONG CIKARANG UTARA, KABUPATEN BEKASI

89100792 CV. AS-SYIFA ANUGERAH RAYA


01/07/2015 30/06/2016

11 1500000001952 KLINIK BERKAT MELIMPAH JABABEKA

KAWASAN INDUSTRI JABABEKA 1B 8 CIKARANG UTARA-BEKASI 8937941 PT BERKAT MELIMPAH

PRATAMA PER/44/092015 RS.TRAUMA CENTRE 01/10/2015 30/09/2016

12 1500000001952KLINIK BERKAT MELIMPAH JABABEKA

KAWASAN INDUSTRI JABABEKA 1B 8 CIKARANG UTARA-BEKASI 8937941

PT BERKAT MELIMPAH PRATAMA PER/39/102016

RS.TRAUMA CENTRE 13/10/2016 31/12/2017

13 1500000000180 KLINIK CENTRAL MEDIKA 1 JL. PILAR SIKATANI NO.84 (WARUNG POJOK) SUKARAYA KARANG BAHAGI

89111103 DR. LIA NURLAELA PER/01/022016 RS.TRAUMA CENTRE

30/08/2016 31/01/2017

14 7-2276024475 KLINIK CENTRAL MEDIKA 1 0125868410 17530 DR LIA NURLAELA PER/01/022016 RS.TRAUMA CENTRE

01/02/2016 31/01/2017

15 1500000000180 KLINIK CENTRAL MEDIKA 1JL. PILAR SIKATANI NO.84 (WARUNG POJOK) SUKARAYA KARANG BAHAGI 89111103 DR. LIA NURLAELA PER/06/022015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

16 1500000001529 KLINIK CENTRAL MEDIKA 2

JL. PILAR ¿ SUKATANI (WARUNG POJOK) RT/RW. 005/006 DESA. SUKARAYA KECAMATAN. KARANG BAHAGIA , KABUPATEN BEKASI

89111103 DR. LIA NURLAELA PER/24/062015RS.TRAUMA CENTRE 01/06/2015 31/01/2016


JL. PILAR ¿ SUKATANI (WARUNG POJOK) RT/RW. 005/006 DESA. SUKARAYA KECAMATAN. KARANG BAHAGIA , KABUPATEN BEKASI

89111103 DR. LIA NURLAELA PER/02/022016RS.TRAUMA CENTRE 30/08/2016 31/01/2017

18 7-2276024473 KLINIK CENTRAL MEDIKA 2 JL.K.H.FUDHOLI(KEBON KOPI) RUKO GREEN CIKARANG ASRI BLOK A NO.3

17530 DR LIA NURLAELA PER/02/022016 RS.TRAUMA CENTRE

01/02/2016 31/01/2017


Periode : 01/01/2015 s/d 31/10/2016


241 / 44607-11-201606:23:31



IKS



JL. PILAR ,SUKATANI (WARUNG POJOK) RT/RW. 005/006 DESA. SUKARAYA KECAMATAN. KARANG BAHAGIA , KABUPATEN BEKASI

89111103 DR LIA NURLAELA PER/03022016 RS.TRAUMA CENTRE 30/08/2016 31/01/2017


JL. PILAR ,SUKATANI (WARUNG POJOK) RT/RW. 005/006 DESA. SUKARAYA KECAMATAN. KARANG BAHAGIA , KABUPATEN BEKASI

89111103 DR LIA NURLAELA PER/25/062015RS.TRAUMA CENTRE 01/06/2015 31/01/2016

21 1400000000388KLINIK CIKARANG MEDICAL CENTER 8934371

RS AWAL BROS HOSPITAL GROUP PER/51/102015

RS.TRAUMA CENTRE 01/10/2015 30/09/2016

22 1400000000549KLINIK 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

23 7-1199819163 KLINIK GRAHA BINA HUSADA

JL.INDUSTRI SELATAN NO.1A, BLOK NN 3A,JABABEKA 2 17530 DR HERTI E.SILALAHI PER/54/122015 RS.TRAUMA

CENTRE 29/12/2015 30/11/2016

24 1400000000247 KLINIK INTRIMED RUKO MEGA MALL BLOK C-2 MM 2100 89882355PT PERSADA SARI MEDIKA PER/33/072015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

25 1500000001977 KLINIK KARUNIA MEDIKA JL. GATOT SUBROTO NO 37 RT 03 RW 02 CKR KOTA

17211 89104266 SRI HANDAYANI PER/53/102015 RS.TRAUMA CENTRE

01/10/2015 30/09/2016

26 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


04/01/2016 04/11/2016

27 1400000000283 KLINIK NAYAKA HUSADA 02JL INDUSTRI PASIR GOMBONG JABABEKA CIKARANG 89835510

PT NAYAKA ERA HUSADA PER/34/082016

RS.TRAUMA CENTRE 19/08/2016 31/07/2017

28 1400000000283 KLINIK NAYAKA HUSADA 02 JL INDUSTRI PASIR GOMBONG JABABEKA CIKARANG 89835510 PT NAYAKA ERA


29 1400000000220 KLINIK NAYAKA HUSADA 03 JL RAYA CIBARUSAH NO.02 SUKARESMI 89677085 NAYAKA HUSADA 03 PER/40/082015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

30 1400000000220 KLINIK NAYAKA HUSADA 03 JL RAYA CIBARUSAH NO.02 SUKARESMI 89677085 NAYAKA HUSADA 03 PER/35/08/2016 RS.TRAUMA CENTRE

19/08/2016 30/06/2017


Periode : 01/01/2015 s/d 31/10/2016


242 / 44607-11-201606:23:31



IKS


31 1500000000479 KLINIK NAYAKA HUSADA 05 JL.RAYA CIBARUSAH KP.MALAKA RT.02 RW 06 89950242 PT NAYAKA ERA


32 1500000000479 KLINIK NAYAKA HUSADA 05 JL.RAYA CIBARUSAH KP.MALAKA RT.02 RW 06 89950242 PT NAYAKA ERA


33 7-2733134691 KLINIK NAYAKA HUSADA 05 JL.RAYA CIBARUSAH KOTA, KEC.CIBARUSAH, KAB. BEKASI

17530 DR H. SRI EMILIA PER/09/032016 RS.TRAUMA CENTRE

01/04/2016 31/03/2017

34 1400000000258KLINIK PRODIA OCCUPATIONAL HEALTH CENTRE

H.USMAR ISMAIL ,JABABEKA 2,CIKARANG 29083408 PT PRODIA OHI INTERNASIONAL


01/07/2015 30/06/2016

35 1400000000258KLINIK PRODIA OCCUPATIONAL HEALTH CENTRE

H.USMAR ISMAIL ,JABABEKA 2,CIKARANG 29083408 PT PRODIA OHI INTERNASIONAL PER/30/072016 RS.TRAUMA

CENTRE 19/07/2016 30/06/2017

36 1400000000389 KLINIK PUTRA MEDIKA 1VILLA MUTIARA CIKARANG DESA CIANTRA 8971932

DR.H.MULYANA SYARIF PANIJA PER/45/092015

RS.TRAUMA CENTRE 01/10/2015 30/09/2016

37 1500000001528 KLINIK PUTRA MEDIKA 2 JL.RAYA CIBARUSAH, DEPAN GERBANG UTAMA VILLA MUTIARA CIKARANG

8971932 MULYANA SYARIP PANIJA


01/06/2015 31/10/2015

38 1500000001528 KLINIK PUTRA MEDIKA 2 JL.RAYA CIBARUSAH, DEPAN GERBANG UTAMA VILLA MUTIARA CIKARANG

8971932 MULYANA SYARIP PANIJA


01/11/2015 31/10/2016

39 1500000001527 KLINIK PUTRA MEDIKA 3 JL.PERUM KOTA SERANG BARU, SERANG 89950333H.MULYANA SYARIP PANIJA PER/27/062015

RS.TRAUMA CENTRE 01/06/2015 30/09/2015

40 1500000001527 KLINIK PUTRA MEDIKA 3 JL.PERUM KOTA SERANG BARU, SERANG 89950333H.MULYANA SYARIP PANIJA PER/46/092015

RS.TRAUMA CENTRE 01/10/2015 30/09/2016

41 7-3991682033 KLINIK SEJAHTERA MEDIKAJL. NOTHERDAM BLOK F/11 KOTA DELTAMAS

17530 22157007 DR. BUDI DARMADI PER/29/062016RS.TRAUMA CENTRE

30/06/2016 31/05/2017

42 1500000001856 KLINIK SETIA 3JL.RAYA SERANG CIBARUSAH, NO.41, RT 012 RW 006 SUKADAMI,CIKARANG SELATAN, KABUPATEN BEKASI

17330 8971240 PT SETIA RAKSA AFINI PER/30/072015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


243 / 44607-11-201606:23:31



IKS


43 1500000000193 KLINIK TAMAN FIRDAUS MEDIKA

PERUMAHAN TAMAN FIRDAUS RESIDENCE BLOK A.06, NO.17 70604934 HERI YULIANSYA, SE PER/08/022015 RS.TRAUMA

CENTRE 01/02/2015 31/01/2016

44 1500000000193 KLINIK TAMAN FIRDAUS MEDIKA

PERUMAHAN TAMAN FIRDAUS RESIDENCE BLOK A.06, NO.17 70604934 HERI YULIANSYA, SE PER/04/02/2016 RS.TRAUMA

CENTRE 30/08/2016 31/01/2017

45 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

46 1400000000004 RS AMANDA CIKARANG JL RAYA SERANG, NO.83, CIKARANG 8971643 DR HAMIDAH, M.KES PER/03/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

47 1400000000004 RS AMANDA CIKARANG JL RAYA SERANG, NO.83, CIKARANG 8971643 DR HAMIDAH, M.KES PER/60/122015 RS.TRAUMA CENTRE 30/08/2016 31/12/2016

48 7-1432249443 RS ANNISA CIKARANGJL CIKARANG BARU, NO.31, KECAMATAN CIKARANG UTARA, KAB.BEKASI 17530

DR.NOOR ARIDA SOFIANA, MBA PER/55/122015

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

49 7-2767325803 RS APRILIA MEDIKA DI JALAN RAYA SETU NO.99, DESA LUBANGBUAYA , KEC SETU, KAB. BEKASI,

17530 DR LENI ASTUTI , DR PER/11/032016 RS.TRAUMA CENTRE

01/04/2016 31/03/2017

50 1500000001495 RS AS-SHOFWANJL. RAYA KARAWANG-BEKASI KM 30, DS BOJONGSARI,KEC KEDUNG WARINGIN, KABUPATEN BEKASI

17211 89141890 PT AS-SHOFWAN TUNGGAL MANDIRI


01/07/2016 30/06/2017

51 1500000001495 RS AS-SHOFWANJL. RAYA KARAWANG-BEKASI KM 30, DS BOJONGSARI,KEC KEDUNG WARINGIN, KABUPATEN BEKASI

17211 89141890PT AS-SHOFWAN TUNGGAL MANDIRI

PER / 19 / 062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

52 1400000000055 RS BHAKTI HUSADAJL.R.E.MARTADINATA BY PASS CIKARANG-BEKASI 89110896

PT HUSADA PURWAKARTA PER/10/032016

RS.TRAUMA CENTRE 01/04/2016 31/03/2017

53 1400000000055 RS BHAKTI HUSADAJL.R.E.MARTADINATA BY PASS CIKARANG-BEKASI

89110896PT HUSADA PURWAKARTA


01/04/2015 31/03/2016

54 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


Periode : 01/01/2015 s/d 31/10/2016


244 / 44607-11-201606:23:31



IKS


55 1500000001950 RS HARAPAN KELUARGA JL. KASUARI RAYA KAV 1A & 1B KOTA JABABEKA CIKARANG BARU, BEKASI 89840745 PT HARAPAN

INTERNASIONAL PER/41/092015 RS.TRAUMA CENTRE 01/10/2015 30/09/2016

56 7-1251921752 RS HOSANA CIKARANG BARU JL ANGGREK, NO.1 B2/II, CIKARANG BARU 17530 JOHANES POSO PER/57/122015 RS.TRAUMA

CENTRE 22/08/2016 31/12/2016

57 7-1250333673 RS HOSANA LIPPO CIKARANG

JL UTAMA BIIE ,NO. 01, LIPPO CIKARANG BEKASI

17530 JOHANNES POSO PER/56/122015 RS.TRAUMA CENTRE

04/01/2016 31/12/2016

58 1400000000003 RS HOSANA MEDICA CIKARANG BARU

JL ANGGREK I B2/2 JABABEKA 29620630 JOHANES POSO PER/02/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

59 1400000000003 RS HOSANA MEDICA CIKARANG BARU JL ANGGREK I B2/2 JABABEKA 29620630 JOHANES POSO PER/57/122015 RS.TRAUMA

CENTRE 31/08/2016 31/12/2016

60 1200000000013RS HOSANA MEDICA LIPPO CIKARANG

JL. RUKO THAMRIN BLOK C-3 LIPPO CIKARANG 8972472 JOHANES POSO PER/01/012015

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

61 1200000000013 RS HOSANA MEDICA LIPPO CIKARANG

JL. RUKO THAMRIN BLOK C-3 LIPPO CIKARANG


31/08/2016 31/12/2016

62 1500000000495 RS MEDIROSSA JL INDUSTRI TEGAL GEDE NO.9, CIKARANGSELATAN

89833216 PT MEDIROSSA MITRA INSANI

PER / 07 /032016 RS.TRAUMA CENTRE

01/04/2016 31/03/2017

63 1500000000495 RS MEDIROSSAJL INDUSTRI TEGAL GEDE NO.9, CIKARANGSELATAN 89833216

PT MEDIROSSA MITRA INSANI PER/15/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

64 7-3786068439RS MEDIROSSA 2 CIBARUSAH

JL. RAYA CIBARUSAH NO.5, DESA SINDANGMULYA, KEC.CIBARUSAH, KAB.BEKASI, 17340 89955555 H.OMIN BASUNI SH PER/16/2016

RS.TRAUMA CENTRE 01/07/2016 30/06/2017

65 1500000001671RS MEDIROSSA 2 CIBARUSAH

JL. RAYA CIBARUSAH NO.5, DESA SINDANGMULYA, KEC.CIBARUSAH, KAB.BEKASI,

17340 89955555 H.OMIN BASUNI SHRS MEDIROSSA2 CIBARUSAH

RS.TRAUMA CENTRE

01/07/2015 30/06/2016

66 1500000001378 RS MITRA MEDIKA JL RAYA JATIWANGI-CIKEDOKAN, CIKARANG BARAT,KAB.BEKASI

98213879 PT MUTIARA ADHI MEDIKA


01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


245 / 44607-11-201606:23:31



IKS


67 1500000001378 RS MITRA MEDIKA JL RAYA JATIWANGI-CIKEDOKAN, CIKARANG BARAT,KAB.BEKASI 98213879 PT MUTIARA ADHI


68 7-3991682037 RS OMNI CIKARANGKOMPLEKS OASIS KAV. 1 JL RAYA CIKARANG CIBARUSAH KEL SUKARESMI KEC CIKARANG SELATAN KAB BEKASI

17530 29779999 PT SARANA MEDITAMA ANUGERAH PER/25/06/2016 RS.TRAUMA

CENTRE 30/06/2016 31/05/2017

69 7-4595056495 RS PERMATA KELUARGA JABABEKA

JL. DR. CIPTO MANGUNKUSUMO BLOK A/1A, MEDICAL CITY, KOTA JABABEKA, BEKASI 17530

17530 2908 3399 PT PERMATA PRIMA HUSADA


05/09/2016 31/12/2017

70 1500000001857 RS RIDHOKA SALMAJL.IMAM BONJOL NO.7, KP.GARDU SAWAH RT.001/001,DESA KALIJAYA ,KEC.CIKARANG BARAT, KABUPATEN

17330 89116527 PT RIDHOKA SALMA PER/31/072015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

71 1500000001857 RS RIDHOKA SALMAJL.IMAM BONJOL NO.7, KP.GARDU SAWAH RT.001/001,DESA KALIJAYA ,KEC.CIKARANG BARAT, KABUPATEN

17330 89116527 PT RIDHOKA SALMA PER/27/062016 RS.TRAUMA CENTRE 01/07/2016 30/06/2017

72 1400000000387 RS SENTRA MEDIKAJL RAYA INDUSTRI PASIR GOMBONG, CIKARANG, BEKASI 8904160 SENTRA MEDIKA GROUP PER/40/102016

RS.TRAUMA CENTRE 13/10/2016 31/12/2017

73 1400000000387 RS SENTRA MEDIKA JL RAYA INDUSTRI PASIR GOMBONG, CIKARANG, BEKASI

8904160 SENTRA MEDIKA GROUP PER / 48 /102015 RS.TRAUMA CENTRE

01/10/2015 30/09/2016

74 1500000001575 RS SETIAJL. RAYA SERANG CIBARUSAH NO.41,KEC.CIKARANG SELATAN, KABUPATEN BEKASI

8971240 DR KURNIA PUJI ASTUTI PER/28/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

75 1500000000844RS SILOAM HOSPITALS LIPPOCIKARANG JL MH THAMRIN KAV 105 LIPPOCIKARANG 29636900 SILOAM HOSPITALS PER/24/062016

RS.TRAUMA CENTRE 30/06/2016 31/05/2017

76 1500000000844RS SILOAM HOSPITALS LIPPOCIKARANG JL MH THAMRIN KAV 105 LIPPOCIKARANG 29636900 SILOAM HOSPITALS PER/18/052015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

77 1100000000024 RS. ANNISA CIKARANG (TC)JL CIKARANG BARU NO 31 CIKARANG UTARA

8904165DR. ISMAIL ALMUCHTARO MPH


01/01/2015 31/12/2015

78 1500000000471 RS. APRILIA MEDIKA JL. RAYA SETU NO. 99 DS. LUBANG BUAYA KEC. SETU

82611565 DR. MOHAMMAD NATSIR PER/11/042016 RS.TRAUMA CENTRE

31/08/2016 31/03/2017


Periode : 01/01/2015 s/d 31/10/2016


246 / 44607-11-201606:23:31



IKS


79 1500000000471 RS. APRILIA MEDIKA JL. RAYA SETU NO. 99 DS. LUBANG BUAYA KEC. SETU 82611565 DR. MOHAMMAD NATSIR PER/12/042015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

80 1500000000472 RS. MUTIARA HUSADA JL. RAYA SUKATANI NO.09 DS. KARANG SENTOSA KARANG BAHAGIA 89161339 DR.MOHAMMAD NATSIR PER/13/042015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

81 1300000000022 RS. PERMATA KELUARGA JL.M.H. THAMRIN KAV 129 LIPPO CIKARANG


01/04/2016 31/03/2017

82 1300000000022 RS. PERMATA KELUARGA JL.M.H. THAMRIN KAV 129 LIPPO CIKARANG


01/04/2015 31/03/2016

83 1500000001374 RSIA CIKARANG MEDIKA JL.KH.FUDHOLI.NO.78 CIKARANG,BEKASI 8902210 DR ULAM FRIDALAM PER/23/062015 RS.TRAUMA CENTRE 01/07/2015 30/06/2016

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 1500000000873 KLINIK ALBARJL TERUSAN KOPO NO 371 KOPO MARGAHAYU 40225

085863333599 YAYASAN LESTARI PER/08/052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

3 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

4 1400000000252 KLINIK AVIATI KOPO JL KOPO NO. 59 PANJUNAN - KOTA BANDUNG

40241 5232291 PT. AVIATI PRIMA CITRA PER/19/062015 RS.TRAUMA CENTRE

01/07/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


247 / 44607-11-201606:23:31



IKS


5 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

6 1500000001810 KLINIK BHAYANGKARA HUSADA POLRES BANDUNG

JL. BHAYANGKARA NO. 1 POLRES BANDUNG - SOREANG 40911 85871980 POLRES BANDUNG PER/17/062015 RS.TRAUMA

CENTRE 22/06/2015 31/12/2015

7 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

8 1500000001538 KLINIK INSANIYAH MEDICAL CENTRE

JL TERUSAN AL FATHU KM 17 RT 05 RW 04 DESA PAMEKARAN SOREANG

40911 85874343 PMI KAB BANDUNG PER/16/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

9 1500000001541 KLINIK KATAPANG JL TERUSAN KOPO NO 65 KATAPANG-SOREANG 40921 21175677 DR.FELIX KASIM, M.KES PER/14/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

10 1500000001541 KLINIK KATAPANGJL TERUSAN KOPO NO 65 KATAPANG-SOREANG 40921 21175677 DR.FELIX KASIM, M.KES PER/18/012016

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

11 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

12 1500000001537 KLINIK LUHUR MEDICA CENTRE

JL JEND SUDIRMAN NO 472/474 ANDIR - BANDUNG

40182 6037679 CV LUHUR MEDICA CENTRE


01/06/2015 31/12/2015

13 1400000000251 KLINIK NAYAKA HUSADA 04JL TERUSAN KOPO KM 12 KATAPANG KAB. BANDUNG 40921 61804614


RS.TRAUMA CENTRE 01/05/2015 31/12/2015

14 1400000000251 KLINIK NAYAKA HUSADA 04JL TERUSAN KOPO KM 12 KATAPANG KAB. BANDUNG 40921 61804614


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

15 1400000000251 KLINIK NAYAKA HUSADA 04JL TERUSAN KOPO KM 12 KATAPANG KAB. BANDUNG

40921 61804614PT. NAYAKA ERA HUSADA


01/05/2015 31/12/2015

16 1500000000871 KLINIK NORMA MASITHA JL RAYA TIMUR NO 41 BANJARAN KAB BANDUNG

40377 5944144 DR HJ ROSIDAH AGUS PER/06/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


248 / 44607-11-201606:23:31



IKS


17 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

18 1500000000911 KLINIK RATNASARI 2 JL RAYA CIWIDEY KP PEER RT 03 RW 23 DESA CIWIDEY KEC CIWIDEY 40973 5927794 APENG HIDAYAT PER/07/052014 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

19 1500000000911 KLINIK RATNASARI 2 JL RAYA CIWIDEY KP PEER RT 03 RW 23 DESA CIWIDEY KEC CIWIDEY

40973 5927794 APENG HIDAYAT PER/13/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

20 1500000000872 KLINIK SAHABAT SEHAT AMPUH

JL TERUSAN KOPO NO 593 KM 11,5 DS PANGAUBAN KATAPANG

40921 5897000 DRS AHMAD SUHANDA PER/09/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

21 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

22 1500000000882KLINIK 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

23 1500000000882 KLINIK SEHAT MEDIKA UTAMA

JL PANGALENGAN SITU CILEUNCA KP SIDAMUKTI RT 01 RW 04 PANGALENGAN

40378 081320605293

APENG HIDAYAT PER/05/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

24 1500000001330 KLINIK SEHAT SEJAHTERA JL LAMAJANG NO.119 DAYEUHKOLOT 40238 5204139 DR RUKHIYAT SYAHIDIN PER/07/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

25 1500000001330 KLINIK SEHAT SEJAHTERA JL LAMAJANG NO.119 DAYEUHKOLOT 40238 5204139 DR RUKHIYAT SYAHIDIN PER/10/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

26 7-4406082675KLINIK SEROJA MEDIKA CANGKUANG JL RAYA SORENG BANJARAN NO123A 40238

DR RATNA SARIHARYANTI PER/26/072016

RS.TRAUMA CENTRE 18/08/2016 31/12/2016

27 1500000001709 KLINIK WIDYA BHAKTI INTI JL. MOCH TOHA NO.77 BANDUNG 40253 5201501 PT.WIDYA BHAKTI INTI PER/18/062015RS.TRAUMA CENTRE

22/06/2015 31/12/2015

28 1500000001709 KLINIK WIDYA BHAKTI INTI JL. MOCH TOHA NO.77 BANDUNG 40253 5201501 PT.WIDYA BHAKTI INTI PER/15/012016 RS.TRAUMA CENTRE

20/09/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


249 / 44607-11-201606:23:31



IKS


29 1500000001709 KLINIK WIDYA BHAKTI INTI JL. MOCH TOHA NO.77 BANDUNG 40253 5201501 PT.WIDYA BHAKTI INTI PER/15/012016 RS.TRAUMA CENTRE 01/01/2016 31/01/2016

30 1400000000080 RSUD AL IHSAN PROV. JABAR JL KIASTRAMANGGALA - BALEENDAH 40258 5940872 PEMDA PROVINSI JABAR PER/03/032015 RS.TRAUMA

CENTRE 01/04/2015 31/12/2015

31 1400000000080 RSUD AL IHSAN PROV. JABAR

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

01/01/2016 31/12/2016

32 1100000000025 RUMAH SAKIT IMMANUEL JL. KOPO NO 161 KOTA BANDUNG 40241 5201051 YAYASAN BRS GK PASUNDAN


01/07/2015 31/12/2015

33 1100000000025 RUMAH SAKIT IMMANUEL JL. KOPO NO 161 KOTA BANDUNG 40241 5201051 YAYASAN BRS GK PASUNDAN PER/01/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

34 1400000000532 RUMAH SAKIT RAJAWALIJL RAJAWALI NO 38 RT 03 RW 10 KEC ANDIR 40181 6011913 YAYASAN KEMANUSIAN PER/06/012016

RS.TRAUMA CENTRE 30/12/2015 31/12/2016

35 1500000001540 RUMAH SAKIT UMUM DAERAH SOREANG

JL ALUN ALUN UTARA NO 1 SOREANG 40911 5891355 PEMERINTAH DAERAH KAB. BANDUNG


04/05/2015 31/12/2015

36 1500000001540 RUMAH SAKIT UMUM DAERAH SOREANG

JL ALUN ALUN UTARA NO 1 SOREANG 40911 5891355 PEMERINTAH DAERAH KAB. BANDUNG


01/01/2016 31/12/2016

37 1500000001715SANTOSA HOSPITAL BANDUNG CENTRAL JL KEBONJATI NO 38 BANDUNG 40181 4248555

PT SANBE PRAKARSA HUSADA PER/012/062015

RS.TRAUMA CENTRE 15/06/2015 31/12/2015

38 1500000001715SANTOSA HOSPITAL BANDUNG CENTRAL JL KEBONJATI NO 38 BANDUNG 40181 4248555

PT SANBE PRAKARSA HUSADA PER/04/012016

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

39 1500000001388SANTOSA HOSPITAL BANDUNG KOPO

KH. WAHID HASYIM NO 461- 463 KOPO BANDUNG

40221 54280555PT SANBE PRAKARSA HUSADA


01/01/2016 31/12/2016

40 1500000001388 SANTOSA HOSPITAL BANDUNG KOPO

KH. WAHID HASYIM NO 461- 463 KOPO BANDUNG

40221 54280555 PT SANBE PRAKARSA HUSADA


15/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


250 / 44607-11-201606:23:31


KANTOR CABANG : K16- KANTOR CABANG BOGOR CILEUNGSI


IKS


1 1500000001174 KLINIK ANGGI KP CIBEBER DS KAHURIPAN KLAPANUNGGAL

29219678 YAYASAN NOGI SEHATI PER/23/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

2 1500000001174 KLINIK ANGGI KP CIBEBER DS KAHURIPAN KLAPANUNGGAL 29219678 YAYASAN NOGI SEHATI PER/23/052015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

3 1500000001174 KLINIK ANGGI KP CIBEBER DS KAHURIPAN KLAPANUNGGAL 29219678 YAYASAN NOGI SEHATI PER/04/012016 RS.TRAUMA

CENTRE 25/01/2016 31/12/2016

4 1500000001514 KLINIK DERA ASSYIFA JL RAYA NAROGONG KM 23 DESA CILEUNGSI 8234492 PT. DURASTIKA SOMA

WIJAYA PER/09/012016 RS.TRAUMA CENTRE 25/01/2016 31/12/2016

5 1500000001514 KLINIK DERA ASSYIFA JL RAYA NAROGONG KM 23 DESA CILEUNGSI

8234492 PT. DURASTIKA SOMA WIJAYA


19/06/2015 31/12/2015

6 1500000001382 KLINIK DR IRMAN PERUM GRIYA ALAM SENTOSA BLOK C9 NO 4 RT 10/08 PASIRANGIN CILEUNGSI

YAYASAN SUMARNO MEDIKA PER/27/062015 RS.TRAUMA

CENTRE 16/06/2015 31/12/2015

7 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

8 1500000001207 KLINIK DR. MARZUKI JL RAYA CILEUNGSI JONGGOL KM 2,2 DR MARZUKI PER/24/062015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

9 1500000001207 KLINIK DR. MARZUKI JL RAYA CILEUNGSI JONGGOL KM 2,2 DR MARZUKI PER/05/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

10 7-1552354085 KLINIK EDELWEISSPERUMAHAN CITRA GRAND CIBUBUR RUKO CITYWALK 2 NO 1-2 JATI KARYA SAMPURNA BEKASI

16820 DR AFRIYANTI SANDHI PER/12/012016 RS.TRAUMA CENTRE

25/01/2016 31/12/2016

11 1500000001990 KLINIK EDELWEISSRUKO CITYWALK 2 NO 1-2 CITRA GRAN CIBUBUR 17435 84303724 DR AFRIYANTI SANDHI PER/36/102015

RS.TRAUMA CENTRE 01/10/2015 31/12/2015

12 1500000001690 KLINIK EKA MEDIKAJL RAYA NAROGONG NO 116 KLAPANUNGGAL 16820 29289475

DR HARUMITI RAMIL,MKK PER/11/012016

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


Periode : 01/01/2015 s/d 31/10/2016


251 / 44607-11-201606:23:31



IKS


13 1500000001690 KLINIK EKA MEDIKA JL RAYA NAROGONG NO 116 KLAPANUNGGAL 16820 29289475 DR HARUMITI

RAMIL,MKK PER/30/062015 RS.TRAUMA CENTRE 26/06/2015 31/12/2015

14 1500000001687 KLINIK GRACIA JL RAYA NAROGONG KM 17 DESA CILEUNGSI 16820 SURYATI SARI ARUM,

SKOM PER/29/062015 RS.TRAUMA CENTRE 26/06/2015 31/12/2015

15 1500000001687 KLINIK GRACIA JL RAYA NAROGONG KM 17 DESA CILEUNGSI

16820 SURYATI SARI ARUM, SKOM


25/01/2016 31/12/2016

16 1500000001331 KLINIK MH THAMRIN MEKARSARI

RUKO EBONY BLOK 23 RT 006/004 DESA CILEUNGSI

8235052 DR RISKA ARISKA YULIANTI


25/01/2016 31/12/2016

17 1500000001331 KLINIK MH THAMRIN MEKARSARI

RUKO EBONY BLOK 23 RT 006/004 DESA CILEUNGSI 8235052 DR RISKA ARISKA

YULIANTI PER/25/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

18 1500000001383KLINIK PKO MUHAMMADIYAH

PERUM PTSC JL ANGGREK BLOK A NO 12 KEC CILEUNGSI DR NUR CAHYANINGSIH PER/07/012016

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

19 1500000001383 KLINIK PKO MUHAMMADIYAH

PERUM PTSC JL ANGGREK BLOK A NO 12 KEC CILEUNGSI

DR NUR CAHYANINGSIH PER/26/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

20 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

21 1500000001691 RS HERMINA MEKARSARI JL RAYA CILEUNGSI JONGGOL KM 1 16820 29232525 VIVI FRIYATNI, SKM PER/31/062015RS.TRAUMA CENTRE 26/06/2015 31/12/2015

22 1500000001927 RS PERMATA JONGGOLJL RAYA JONGGOL NO 1 A SUKAMANAH JONGGOL 16120 89931333

DR EVY FEBRINA NURPENI, MARS PER/32/062015

RS.TRAUMA CENTRE 01/07/2015 31/12/2015

23 1500000001927 RS PERMATA JONGGOLJL RAYA JONGGOL NO 1 A SUKAMANAH JONGGOL

16120 89931333DR EVY FEBRINA NURPENI, MARS


25/01/2016 31/12/2016

24 1400000000327 RSTC MH THAMRIN CILEUNGSI

JL RAYA NAROGONG KM 16 LIMUSNUNGGAL CILEUNGSI

8235052 DR ABDUL RADJAK PER/02/012016 RS.TRAUMA CENTRE

21/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


252 / 44607-11-201606:23:31



IKS


25 1400000000327 RSTC MH THAMRIN CILEUNGSI

JL RAYA NAROGONG KM 16 LIMUSNUNGGAL CILEUNGSI 8235052 DR ABDUL RADJAK PER/35/092015 RS.TRAUMA

CENTRE 01/09/2015 31/12/2015

26 1500000000590 TC RSIA KENARI GRAHA MEDIKA

GRIYA KENARI MAS BLOK B2 CILEUNGSI BOGOR 8230426 DRA FATIMAH PER/15/032016 RS.TRAUMA

CENTRE 11/05/2016 31/12/2016

27 1500000000590 TC RSIA KENARI GRAHA MEDIKA

GRIYA KENARI MAS BLOK B2 CILEUNGSI BOGOR

8230426 DRA FATIMAH PER/21/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

KANTOR CABANG : K17- KANTOR CABANG TANGERANG CIMONE


IKS


1 7-3271915318 KLINIK GEBANG MEDIKAJL PRABU KIAN SANTANG NO 30 RT 001 RW 001 KEL GEBANG RAYA KEC PERIUK KOTA TANGERANG

15131 55773345 DRA PUJI WAHYUNI PER / 09 / 042016

RS.TRAUMA CENTRE

10/05/2016 31/03/2017

2 1500000001870 KLINIK RATNA MEDIKA JL.METROLITE RAYA BLOK SQ 2 NO.3 PURI JATAKE INDAH


01/07/2015 31/12/5015

3 1400000000281 KLINIK SAHABATJL TELESONIK UJUNG NO 65 KEL BUNDERT RT 09/02 CIKUPA TANGERANG 59300041 PER/05/012015

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

4 1500000000649 RS DINDA GALUH NO 2 JATIUWUNG 15133 PT DINDA MEDISTRA PER/04/042016RS.TRAUMA CENTRE 26/01/2016 31/12/2016

5 1500000000649 RS DINDA GALUH NO 2 JATIUWUNG 15133 PT DINDA MEDISTRA PER/14/042015RS.TRAUMA CENTRE

01/04/2015 31/12/2015

6 1500000001827 RS MELATI JL MERDEKA NO 92 KEL GERENDENG KARAWACI KOTA TANGERANG

15111 5523945 PT MELATI MEDIKA SEJAHTERA


01/07/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


253 / 44607-11-201606:23:31



IKS


7 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

8 1100000000004 RSU AN NISA JL GATOT SUBROTO NO 96 KM 3, CIBODAS 5525564 DR EDIANSYAH, MARS PER/03/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

9 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

10 1100000000005 RSU ARIYA MEDIKA JL INDUSTRI RAYA I BLOK A NO.1-10 JATAKE

5902226 DR E TRISNO SUSILO PER/02/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

KANTOR CABANG : K18- KANTOR CABANG DEPOK


IKS


1 04047 ASY-SYIFA MEDICAL CENTER

JL RAYA DEPOK CINERE NO 9 PARUNG BINGUNG SAWANGAN DEPOK

77883905 DR SOBARI 9878341 22/09/2015 30/11/2015

2 1500000001929 KLINIK BHAKTI JAYA JL. KARTINI - CITAYAM RAYA NO.18 A 16411 77203062 DRG.SRI SULISWATI,MM PER/32/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

3 1500000001929 KLINIK BHAKTI JAYA JL. KARTINI - CITAYAM RAYA NO.18 A 16411 77203062 DRG.SRI SULISWATI,MM PER/15/072015 FFS 01/08/2015 31/12/2015

4 1500000001808 KLINIK IRENK MEDIKA JL BAHAGIA RAYA NO 18 DEPOK TIMUR 16413 7715039ARUJI AMBAR SUKOCO, SE

PER/11/062015 FFS 01/07/2015 31/12/2015

5 1500000001808 KLINIK IRENK MEDIKA JL BAHAGIA RAYA NO 18 DEPOK TIMUR 16413 7715039 ARUJI AMBAR SUKOCO, SE


01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


254 / 44607-11-201606:23:31



IKS


6 1500000001922 KLINIK YANI MEDIKA JL KARTINI NO 48 RT.03/09 KEL DEPOK KEC PANCORAN MAS 16414 77219553 DR YANI HARYANI PER/14/062015 FFS 01/07/2015 31/12/2015

7 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

8 1500000001971 PRAKTEK DR MAS'UD JL CINERE RAYA PERUMAHAN GRIYA CINERE 2 KAV 48 NO 12A LIMO

16421 7533780 DR. MAS'UD PER/21/102015 RS.TRAUMA CENTRE

01/10/2015 31/12/2015

9 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

10 1400000000184 RS BHAKTI YUDHA JL RAYA SAWANGAN NO 2A DEPOK 16511 7520082 THAMAS INVESTAMA GUNA PER/13/062015 RS.TRAUMA

CENTRE 05/06/2015 31/12/2015

11 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

12 1400000000183 RS BHAYANGKARA SIKESJAS KORBRIMOB

JL RAYA AKSES UI KELAPA DUA DEPOK 87704691 DR TAUFIK PER/18/062015 RS.TRAUMA CENTRE

06/06/2015 31/12/2015

13 1400000000183 RS BHAYANGKARA SIKESJAS KORBRIMOB

JL RAYA AKSES UI KELAPA DUA DEPOK 87704691 DR TAUFIK PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

14 1400000000528 RS CITRA MEDIKA DEPOKJL.RAYA KALIMULYA NO.68 CILODONG KOTA KEMBANG DEPOK 29671000 DR NENCY PER/28/122015

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

15 7-2718973400 RS HERMINA DEPOKJL RAYA SILIWANGI NO 50 PANCORAN MASDEPOK 16431 77202525

PT MEDIKALOKA HUSADA PER/08/032016

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

16 1500000001916 RS PERMATA DEPOKJL RAYA MUCHTAR NO.22 SAWANGAN DEPOK

16511 29669000PT MUFIDAH MEDIKA SAWANGAN


04/01/2016 31/12/2016

17 1500000001916 RS PERMATA DEPOK JL RAYA MUCHTAR NO.22 SAWANGAN DEPOK

16511 29669000 PT MUFIDAH MEDIKA SAWANGAN


01/07/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


255 / 44607-11-201606:23:31



IKS


18 1500000001811 RS PERMATA DEPOK JL RAYA MUCHTAR NO 22 SAWANGAN 16511 29669000 PT MUFIDAH MEDIKA SAWANGAN PER/10/062015 FFS 01/07/2015 31/12/2015

19 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

20 1400000000181 RS SENTRA MEDIKA CISALAK

JL RAYA JAKARTA BOGOR KM 33 CISALAK DEPOK

8743790 DR HERMAN WIDYATOMO


06/06/2015 31/12/2015

21 1400000000182 RS SIMPANGAN DEPOK JL RAYA JAKARTA BOGOR KM 36 SUKAMAJU DEPOK

D WARSITO PER/17/062015 RS.TRAUMA CENTRE

10/06/2015 31/12/2015

22 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

23 1400000000180 RS TUGU IBUJL RAYA JAKARTA BOGOR KM 29 CIMANGGIS DEPOK 8710870 H MARIS RINALDI PER/16/062015

RS.TRAUMA CENTRE 10/06/2015 31/12/2015

24 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

25 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

26 1400000000285 RSTC GRHA PERMATA IBUJL KH USMAN NO 168 BEJI KUKUSAN DEPOK 7778899 DR PARAMITA PER/19/072015

RS.TRAUMA CENTRE 01/08/2015 31/12/2015

KANTOR CABANG : K19- KANTOR CABANG TANGERANG BSD


Periode : 01/01/2015 s/d 31/10/2016


256 / 44607-11-201606:23:31



IKS


1 1500000001019 BLKI PROVINSI BANTEN JL. RAYA SERPONG KM 12 SERPONG UTARAKOTA TANGSEL 5383042 PROVINSI BANTEN PER/19/052015 RS.TRAUMA

CENTRE 26/05/2015 31/05/2016

2 1500000000448 KLINIK AMIRA GRIYA LOKA BSD TANGSEL DR MURTININGRUM PER/13/032015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

3 1500000000448 KLINIK AMIRA GRIYA LOKA BSD TANGSEL DR MURTININGRUM PER/04/042016 RS.TRAUMA CENTRE

01/04/2016 31/03/2017

4 1500000001463 KLINIK ASA MEDIKA CV HOMY MEDICARE / ALEX


01/07/2015 30/06/2016

5 1500000000621 KLINIK DIANA PERMATA MEDIKA

JL MH. THAMRIN KAV. 888C PANUNGGANGAN PINANG 5397314 DR. HJ. DIANA

FACHRUDIN PER/015/042015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

6 1500000000621KLINIK DIANA PERMATA MEDIKA

JL MH. THAMRIN KAV. 888C PANUNGGANGAN PINANG 5397314

DR. HJ. DIANA FACHRUDIN PER/05/042016

RS.TRAUMA CENTRE 16/05/2016 31/03/2017

7 1500000000323 KLINIK DR RANNY JL BUARAN RAYA RT 003/001 SERPONG 75874222 PER/06/042016 RS.TRAUMA CENTRE

16/05/2016 31/03/2017

8 1500000000323 KLINIK DR RANNY JL BUARAN RAYA RT 003/001 SERPONG 75874222 PER/07/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

9 1500000000441 KLINIK MAKMUR JAYA JL CEGER RAYA - PONDOK ARENDR AYAT RAHAYU SP.RAD. MKES PER/07/042016

RS.TRAUMA CENTRE 16/05/2016 31/03/2017

10 1500000000441 KLINIK MAKMUR JAYA JL CEGER RAYA - PONDOK ARENDR AYAT RAHAYU SP.RAD. MKES PER/11/032015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

11 1500000000440KLINIK MAKMUR JAYA I - CIPUTAT

CIPUTAT TIMURDR AYAT RAHAYU SP.RAD. M.KES


16/05/2016 31/03/2017

12 1500000000440 KLINIK MAKMUR JAYA I - CIPUTAT

CIPUTAT TIMUR DR AYAT RAHAYU SP.RAD. M.KES


01/04/2015 31/03/2016


Periode : 01/01/2015 s/d 31/10/2016


257 / 44607-11-201606:23:31



IKS


13 1500000000442 KLINIK MAKMUR JAYA II - PAMULANG CIPUTAT TIMUR DR AYAT RAHAYU

SP.RAD MKES PER/09/042016 RS.TRAUMA CENTRE 01/04/2016 31/03/2017

14 1500000000442 KLINIK MAKMUR JAYA II - PAMULANG CIPUTAT TIMUR DR AYAT RAHAYU

SP.RAD MKES PER/10/032015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

15 1500000001521 KLINIK PUTI HANDIYAH 7562156 DR. HJ. NITA GILIK, MM PER/27/062015 RS.TRAUMA CENTRE

22/06/2015 30/06/2016

16 1500000001875 KLINIK RAJA MEDIKA JL CENDANA 2 RT /RW 005/004 NO 17 KAV SERPONG

15310 5386400 JAMES TAMPUBOLON PER/31/072015 RS.TRAUMA CENTRE

10/07/2015 09/07/2016

17 1500000001613 KLINIK RAZZAAQ JL BHAYANGKARA RAYA NO 9 RT/RW 001/004 PONDOK JAGUNG TIMUR SERPONG 70947446 INDRA GUSMARDI

MARAN PER/28/062015 RS.TRAUMA CENTRE 01/07/2015 30/06/2016

18 1500000000443 KLINIK SURADITAJL WIJAYA KUSUMA RAYA 10 - 11 PERUMNAS SURADITA DR HJ SITI MURWANI PER/10/042016

RS.TRAUMA CENTRE 01/04/2016 31/03/2017

19 1500000000443 KLINIK SURADITA JL WIJAYA KUSUMA RAYA 10 - 11 PERUMNAS SURADITA

DR HJ SITI MURWANI PER/08/032015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

20 1500000001286 KLINIK TIGA MANDIRI 74711292 DR. BAMBANG SUTOTO PER/23/062015 RS.TRAUMA CENTRE

15/06/2015 30/06/2016

21 1500000000512 RS BETHSAIDA HOSPITAL GADING SERPONGPT. BETHSAIDA HOSPITAL INTERNATIONAL


22 1500000000709 RS BHINEKA BAKTI HUSADA JL. CABE RAYA NO. 17 PAMULANG 7490018PT. BHINEKABAKTIHUSADA PER/017/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

23 7-5032311013 RS HERMINA SERPONGJL RAYA PUSPITEK KP SETU BUARAN KEC SERPONG TANGERANG SELATAN

15318 75884999PT MEDIKALOKA SERPONG


04/10/2016 31/12/2016

24 1500000001210 RS IMC BINTARO JL RAYA JOMBANG NO 56 BINTARO SEKTOR IX CIPUTAT TANGSEL

7456379 YAYASAN ICHSAN PER/12/062016 RS.TRAUMA CENTRE

18/07/2016 30/05/2017


Periode : 01/01/2015 s/d 31/10/2016


258 / 44607-11-201606:23:31



IKS


25 1500000001210 RS IMC BINTARO JL RAYA JOMBANG NO 56 BINTARO SEKTOR IX CIPUTAT TANGSEL 7456379 YAYASAN ICHSAN PER/21/052015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

26 1500000001018 RS MEDIKA BSD JL LETNAN SOETOPO KAV KOM III A NO 7 BSD CITY SERPONG 5373396 PT KHASANAH PUTERA

JAKARTA MEDIKA PER/13/062016 RS.TRAUMA CENTRE 18/07/2016 30/05/2017

27 1500000001018 RS MEDIKA BSD JL LETNAN SOETOPO KAV KOM III A NO 7 BSD CITY SERPONG

5373396 PT KHASANAH PUTERA JAKARTA MEDIKA


01/06/2015 30/05/2016

28 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

29 1400000000079 RS PERMATA PAMULANG JL RAYA SILIWANGI NO 1A PAMULANG 74704999 DR TAUFIK ZAIN SPOG (K) PER/03/042016 RS.TRAUMA

CENTRE 02/05/2016 30/04/2017

30 1400000000079 RS PERMATA PAMULANG JL RAYA SILIWANGI NO 1A PAMULANG 74704999DR TAUFIK ZAIN SPOG (K) PER/01/012015

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

31 1500000001209 RS SARI ASIH CIPUTAT JL OTISTA RT 001/011 KELURAHAN CIPUTAT KEC CIPUTAT KOTA TANGSEL

7410808 PT SARI ASIH MANGUN PERSADA


04/10/2016 31/12/2017

32 1500000001209 RS SARI ASIH CIPUTAT JL OTISTA RT 001/011 KELURAHAN CIPUTAT KEC CIPUTAT KOTA TANGSEL

7410808 PT SARI ASIH MANGUN PERSADA


01/06/2015 31/05/2016

KANTOR CABANG : L00- KANTOR CABANG SEMARANG PEMUDA


IKS


1 1500000001801

BALAI PELATIHAN TRANSMIGRASI DAN PENYANDANG CACAT PROVJATENG

JL BRIGJEN SUDIARTO NO 375 SEMARANG 50113 6720566 M NATSIR NOOR EFFENDY SH MSI


16/08/2016 31/12/2018


Periode : 01/01/2015 s/d 31/10/2016


259 / 44607-11-201606:23:31



IKS


2 1500000001801

BALAI PELATIHAN TRANSMIGRASI DAN PENYANDANG CACAT PROVJATENG

JL BRIGJEN SUDIARTO NO 375 SEMARANG 50113 6720566 M NATSIR NOOR EFFENDY SH MSI PER/17/062015 RS.TRAUMA

CENTRE 30/06/2015 29/06/2016

3 1500000001753 KLINIK NAYAKA HUSADA 01 JL JEND SUDIRMAN NO187-189 RUKO SILIWANGI PLAZA D2 SMG 50263 91086136 KLINIK NAYAKA

HUSADA per/19/062016 RS.TRAUMA CENTRE 09/09/2016 31/12/2018

4 1500000001753 KLINIK NAYAKA HUSADA 01JL JEND SUDIRMAN NO187-189 RUKO SILIWANGI PLAZA D2 SMG 50263 91086136

KLINIK NAYAKA HUSADA PER/16/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

5 1500000001800 KLINIK PERMATA SEHAT JL BUKIT BARISAN C1 NO 11 50184 7628785 DR YETTI NASTUTI PER/18/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

6 1500000001720 PUSKEMAS BULU LOR JL BANOWATI SELATAN II SEMARANG 50179 3548550 ENDAH EMAYANTI SKM MSI PER/14/4/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

7 1500000001720 PUSKEMAS BULU LOR JL BANOWATI SELATAN II SEMARANG 50179 3548550ENDAH EMAYANTI SKM MSI

PER/16-04/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

8 1500000001719 PUSKESMAS BANDARHARJO JL CUMI-CUMI RAYA BANDARHARJO SEMARANG

50175 3564787 TRI SUSILO HADI SKM MKES


01/06/2015 31/05/2016

9 1500000001719 PUSKESMAS BANDARHARJO JL CUMI-CUMI RAYA BANDARHARJO SEMARANG

50175 3564787 TRI SUSILO HADI SKM MKES

PER/16-03/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

10 1500000001734 PUSKESMAS BANGETAYU JL RAYA BANGETAYU GENUK SMG 50115 6584353DR SURYANTO SETYO PRIHADI

PER/16-16/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

11 1500000001734 PUSKESMAS BANGETAYU JL RAYA BANGETAYU GENUK SMG 50115 6584353 DR SURYANTO SETYO PRIHADI

PER/14/16/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

12 1500000001765 PUSKESMAS BOJA 01 JL RAYA BEBENGAN NO 201C BOJA 51381 571025 DR LELY YULIANTYPER/15-20/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

13 1500000001765 PUSKESMAS BOJA 01 JL RAYA BEBENGAN NO 201C BOJA 51381 571025 DR LELY YULIANTY PER/15/20/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


260 / 44607-11-201606:23:31



IKS


14 1500000001774 PUSKESMAS BOJA 2 JL DESA NGABEAN 51381 41001962 DR AGUS PRIBADI PER/15-21/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

15 1500000001774 PUSKESMAS BOJA 2 JL DESA NGABEAN 51381 41001962 DR AGUS PRIBADI PER/15/21/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

16 1500000001796 PUSKESMAS BRANGSONG 1 JL SIDOREJO NO 43 SIDOREJO BRANGSONG 51371 3688944 DR WIWIEN YUNITA INDRIYATI

PER/15-09/022016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

17 1500000001796 PUSKESMAS BRANGSONG 1 JL SIDOREJO NO 43 SIDOREJO BRANGSONG 51371 3688944 DR WIWIEN YUNITA INDRIYATI


01/06/2015 31/05/2016

18 1500000001767 PUSKESMAS BRANGSONG 2 JL LETNAN SUYONO NO 10 BRANGSONG 51371 383107 DR SRIYATI PER/15/10/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

19 1500000001767 PUSKESMAS BRANGSONG 2 JL LETNAN SUYONO NO 10 BRANGSONG 51371 383107 DR SRIYATIPER/15-10/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

20 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

21 1500000001722 PUSKESMAS BUGANGAN JL CILOSARI RAYA SEMARANG 50126 3546061 DRG RAHMA DEVI PER/14/5/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

22 1500000001722 PUSKESMAS BUGANGAN JL CILOSARI RAYA SEMARANG 50126 3546061 DRG RAHMA DEVIPER/16-05/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

23 1500000001797 PUSKESMAS CANDI LAMA JL DR WAHIDIN NO 22 SEMARANG 8310515DRG ERMI NURYANTI MARS

PER/16-13/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

24 1500000001797 PUSKESMAS CANDI LAMA JL DR WAHIDIN NO 22 SEMARANG 8310515DRG ERMI NURYANTI MARS

PER/14/13/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

25 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 : 01/01/2015 s/d 31/10/2016


261 / 44607-11-201606:23:31



IKS


26 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

27 1500000001730 PUSKESMAS GAYAMSARI JL SLAMET RIYADI NO 4A SMG 6744855 DR ASRI NUGRAHINI K PER/14/12/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

28 1500000001730 PUSKESMAS GAYAMSARI JL SLAMET RIYADI NO 4A SMG 6744855 DR ASRI NUGRAHINI K PER/16-12/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

29 1500000001781 PUSKESMAS GEMUH 1 JL PUSKESMAS NO 15 PAMRIHAN 51351 388105 DR HJ SITI QOMARIYAH PER/15/13/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

30 1500000001781 PUSKESMAS GEMUH 1 JL PUSKESMAS NO 15 PAMRIHAN 51351 388105 DR HJ SITI QOMARIYAH PER/15-13/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

31 1500000001782 PUSKESMAS GEMUH 2 DS GEBANG KEC GEMUH 51356 5704550 DR ANDI SETIAWANPER/15/14/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

32 1500000001782 PUSKESMAS GEMUH 2 DS GEBANG KEC GEMUH 51356 5704550 DR ANDI SETIAWAN PER/15-14/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

33 1500000001733 PUSKESMAS GENUK JL GENUKSARI RAYA GENUK SMG 50117 8584188 DR RENI ERVINA PER/16-30/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

34 1500000001733 PUSKESMAS GENUK JL GENUKSARI RAYA GENUK SMG 50117 8584188 DR RENI ERVINAPER/14/30/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

35 7-1435773598 PUSKESMAS GEYER I JL. RAYA SOLO PURWADADI, KEC. GEYER 58172 00551107DR. AGUNG PROBO M, M.SI PER/22-4/112015

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

36 7-1435791349 PUSKESMAS GEYER II DS. BANGSRI, KEC. GEYER 58172EDI SUCIPTO, S.KEP.M.KES

PER/22-5/112015RS.TRAUMA CENTRE

15/01/2016 31/12/2016

37 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


Periode : 01/01/2015 s/d 31/10/2016


262 / 44607-11-201606:23:31



IKS


38 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

39 7-1444574355 PUSKESMAS GROBOGAN JL. PUGER NO.160, KEC. GROBOGAN 58152 02927703006 DR. AGUS BUDIYANTO PER/22-8/112015 RS.TRAUMA

CENTRE 18/01/2016 31/12/2016

40 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

41 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

42 1500000001743 PUSKESMAS GUNUNGPATI JL RAYA GUNUNGPATI-UNGARAN SMG 6932140 DR YUNI ASTUTI PER/14/22/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

43 1500000001743 PUSKESMAS GUNUNGPATI JL RAYA GUNUNGPATI-UNGARAN SMG 6932140 DR YUNI ASTUTIPER/16-22/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

44 1500000001721 PUSKESMAS HALMAHERA JL HALMAHERA RAYA NO 38 SEMARANG 8414894 DR MUH HIDAYANTO PER/16-27/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

45 1500000001721 PUSKESMAS HALMAHERA JL HALMAHERA RAYA NO 38 SEMARANG 8414894 DR MUH HIDAYANTO PER/14/27/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

46 1500000001731 PUSKESMAS KAGOK JL TELOMOYO NO 3 SMG 50111 8312573IDA ULI BASA BUTAR BUTAR SKM

PER/14/14/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

47 1500000001731 PUSKESMAS KAGOK JL TELOMOYO NO 3 SMG 50111 8312573IDA ULI BASA BUTAR BUTAR SKM

PER/16-14/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

48 1500000001762 PUSKESMAS KALIWUNGU JL RAYA KALIWUNGU NO 9A 51372 382012DR FATCHROYATI SUSANA

PER/15/22/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

49 1500000001762 PUSKESMAS KALIWUNGU JL RAYA KALIWUNGU NO 9A 51372 382012 DR FATCHROYATI SUSANA

PER/15-22/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018


Periode : 01/01/2015 s/d 31/10/2016


263 / 44607-11-201606:23:31



IKS


50 1500000001771 PUSKESMAS KALIWUNGU SELATAN JL RAYA BOJA KALIWUNGU DS DARUPONO 51372 92080045 DR HESTI

SULISTIYANINGSIHPER/15/23/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

51 1500000001771 PUSKESMAS KALIWUNGU SELATAN JL RAYA BOJA KALIWUNGU DS DARUPONO 51372 92080045 DR HESTI

SULISTIYANINGSIHPER/15-23/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

52 1500000001793 PUSKESMAS KANGKUNG 1 JL KH IBRAHIM NO 6 KANGKUNG 51353 383181 DR ISTIAWATI PER/15/25/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

53 1500000001793 PUSKESMAS KANGKUNG 1 JL KH IBRAHIM NO 6 KANGKUNG 51353 383181 DR ISTIAWATI PER/15-25/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

54 1500000001794 PUSKESMAS KANGKUNG 2 DS SENDANG KULON KEC KANGKUNG 51353 5703134 DR UMIYATI PER/15-26/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

55 1500000001794 PUSKESMAS KANGKUNG 2 DS SENDANG KULON KEC KANGKUNG 51353 5703134 DR UMIYATIPER/15/26/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

56 1500000001725 PUSKESMAS KARANG AYU JL KENCONO WUNGU III NO 28 SMG 50144 7606065 DR SITI MASFUFAH MKES


01/06/2015 31/05/2016

57 1500000001725 PUSKESMAS KARANG AYU JL KENCONO WUNGU III NO 28 SMG 50144 7606065 DR SITI MASFUFAH MKES

PER/16-07/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

58 1500000001723 PUSKESMAS KARANG DORO JL RADEN PATAH SEMARANG 50122 3540035 DR WAHYUDIPER/16-28/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

59 1500000001723 PUSKESMAS KARANG DORO JL RADEN PATAH SEMARANG 50122 3540035 DR WAHYUDIPER/14/28/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

60 1500000001746PUSKESMAS KARANG MALANG

JL RM SOEBAGIONO TJONDROKUSUMO MIJEN SMG

70783410DR ANASIH RACHMAWATI

PER/14/35/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

61 1500000001746 PUSKESMAS KARANG MALANG

JL RM SOEBAGIONO TJONDROKUSUMO MIJEN SMG

70783410 DR ANASIH RACHMAWATI

PER/16-35/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018


Periode : 01/01/2015 s/d 31/10/2016


264 / 44607-11-201606:23:31



IKS


62 1500000001751 PUSKESMAS KARANGANYAR JL TIRTO KARANGANYAR TUGU SMG 50135 8662080 DR SRI MAHARSI PER/16-

26/062016RS.TRAUMA CENTRE 25/08/2016 31/12/2018

63 1500000001751 PUSKESMAS KARANGANYAR JL TIRTO KARANGANYAR TUGU SMG 50135 8662080 DR SRI MAHARSI PER/14/26/06201

5RS.TRAUMA CENTRE 01/06/2015 31/05/2016

64 7-1444951638 PUSKESMAS 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

65 7-1445380831 PUSKESMAS KARANGRAYUNG II

JL. RAYA TELAWAH, KEC. KARANGRAYUNG

58163 PUJIYONO, SKM,M.KES PER/22-12/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

66 7-1445437092 PUSKESMAS KEDUNGJATI JL. RAYA KEDUNGJATI, KEC. KEDUNGJATI 58167 0292658088 DR. HARDJOKO PER/22-

13/112015RS.TRAUMA CENTRE 18/01/2016 31/12/2016

67 1500000001737PUSKESMAS KEDUNGMUNDU SAMBIROTO RT 1/RW 1 TEMBALANG SMG 50273 6717053 TURI SETYOWATI

PER/14/18/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

68 1500000001737 PUSKESMAS KEDUNGMUNDU

SAMBIROTO RT 1/RW 1 TEMBALANG SMG 50273 6717053 TURI SETYOWATI PER/16-18/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

69 1500000001758 PUSKESMAS KENDAL 01 JL PAHLAWAN I SUKODONO KENDAL 51311 3843409 DINAS KESEHATAN KAB KENDAL

PER/15/29/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

70 1500000001758 PUSKESMAS KENDAL 01 JL PAHLAWAN I SUKODONO KENDAL 51311 3843409DINAS KESEHATAN KAB KENDAL

PER/15-29/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

71 1500000001769 PUSKESMAS KENDAL 2 JL KARANG KEMBANG KARANGSARI 51318 383309 DR SITI MUSRIAHPER/15-30/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2016

72 1500000001769 PUSKESMAS KENDAL 2 JL KARANG KEMBANG KARANGSARI 51318 383309 DR SITI MUSRIAHPER/15/30/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

73 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 : 01/01/2015 s/d 31/10/2016


265 / 44607-11-201606:23:31



IKS


74 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

75 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

76 1500000001728 PUSKESMAS KROBOKAN JL ARIBUANA NO 1 SEMARANG 50141 7610084 SATIDA F SKM MKES PER/14/10/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

77 1500000001728 PUSKESMAS KROBOKAN JL ARIBUANA NO 1 SEMARANG 50141 7610084 SATIDA F SKM MKES PER/16-10/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

78 1500000001724 PUSKESMAS LAMPER TENGAH JL LAMPER TENGAH GANG XV SEMARANG 84444808 DR SULISTYOWATI PER/16-

06/062016RS.TRAUMA CENTRE 25/08/2016 31/12/2018

79 1500000001724PUSKESMAS LAMPER TENGAH JL LAMPER TENGAH GANG XV SEMARANG 84444808 DR SULISTYOWATI PER/14/6/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

80 1500000001726 PUSKESMAS LEBDOSARI JL TAMAN LEBDOSARI RT 7/RW VI SMG 50145 7610207 DR UMI QULSUM MKES PER/16-08/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

81 1500000001726 PUSKESMAS LEBDOSARI JL TAMAN LEBDOSARI RT 7/RW VI SMG 50145 7610207 DR UMI QULSUM MKES PER/14/8/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

82 1500000001768 PUSKESMAS LIMBANGAN JL RAYA LIMBANGAN NO 3 51383 3673283 DR SLAMET RIYANTO PER/15/8/062015RS.TRAUMA CENTRE 01/06/2015 31/05/2016

83 1500000001768 PUSKESMAS LIMBANGAN JL RAYA LIMBANGAN NO 3 51383 3673283 DR SLAMET RIYANTOPER/15-08/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

84 1500000001750 PUSKESMAS MANGKANG JL JEND OERIP SOEMOHARJO KM 16 SMG 50156 8660675 DR BUDI MULYANTOPER/14/37/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

85 1500000001750 PUSKESMAS MANGKANG JL JEND OERIP SOEMOHARJO KM 16 SMG 50156 8660675 DR BUDI MULYANTO PER/16-37/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018


Periode : 01/01/2015 s/d 31/10/2016


266 / 44607-11-201606:23:31



IKS


86 1500000001727 PUSKESMAS MANYARAN JL ABDUR RAHMAN SALEH 267 SMG 50149 7601883 SUFARKAH SKM PER/16-09/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

87 1500000001727 PUSKESMAS MANYARAN JL ABDUR RAHMAN SALEH 267 SMG 50149 7601883 SUFARKAH SKM PER/14/9/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

88 1500000001745 PUSKESMAS MIJEN JL RAYA MIJEN NO 146-148 SMG 7711083 DR YETTI NASTUTI PER/16-34/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

89 1500000001745 PUSKESMAS MIJEN JL RAYA MIJEN NO 146-148 SMG 7711083 DR YETTI NASTUTI PER/14/34/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

90 1500000001718 PUSKESMAS MIROTO JL TAMAN SETERAN RAYA NO 3 SEMARANG 50134 3552542 SUMARTOPO SKM PER/14/2/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

91 1500000001718 PUSKESMAS MIROTOJL TAMAN SETERAN RAYA NO 3 SEMARANG 50134 3552542 SUMARTOPO SKM

PER/16-02/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

92 1500000001749 PUSKESMAS NGALIYAN JL WISMA SARI RAYA NGALIYAN SMG 7608795 DINKES KOTA SEMARANG`

PER/16-36/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

93 1500000001749 PUSKESMAS NGALIYAN JL WISMA SARI RAYA NGALIYAN SMG 7608795 DINKES KOTA SEMARANG`

PER/14/36/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

94 1500000001792 PUSKESMAS NGAMPEL JL SUNAN AMPEL KM 2 NGAMPEL KULON 51357 383084SUGENG UJI HARTONO SKM

PER/15/12/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

95 1500000001792 PUSKESMAS NGAMPEL JL SUNAN AMPEL KM 2 NGAMPEL KULON 51357 383084SUGENG UJI HARTONO SKM

PER/15-12/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

96 7-1445738346 PUSKESMAS NGARINGAN JL. RAYA BLORA, KEC. NGARINGAN 58193081225177040

M. ABDUL RAUF, S.KEP, M.KES

PER/22-17/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

97 1500000001729 PUSKESMAS NGEMPLAK SIMONGAN

JL SRININDITO IV RT 8/RW 1 SMG 50148 7610212 SRI ANDRIYANI SKM MKES

PER/16-11/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018


Periode : 01/01/2015 s/d 31/10/2016


267 / 44607-11-201606:23:31



IKS


98 1500000001729 PUSKESMAS NGEMPLAK SIMONGAN JL SRININDITO IV RT 8/RW 1 SMG 50148 7610212 SRI ANDRIYANI SKM

MKESPER/14/11/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

99 1500000001739 PUSKESMAS NGESREP JL TEUKU UMAR NO 271 SMG 50262 7474113 DR AHNAF PER/14/32/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

100 1500000001739 PUSKESMAS NGESREP JL TEUKU UMAR NO 271 SMG 50262 7474113 DR AHNAF PER/16-32/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

101 1500000001740 PUSKESMAS PADANGSARI JL MERANTI RAYA BANYUMANIK SMG 50261 7472460 DR JULIUS TJANDRA PER/16-20/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

102 1500000001740 PUSKESMAS PADANGSARI JL MERANTI RAYA BANYUMANIK SMG 50261 7472460 DR JULIUS TJANDRA PER/14/20/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

103 1500000001777 PUSKESMAS PAGERUYUNG DS PUCAKWANGI PAGERUYUNG 51361 5790987 DR SULASIH PER/15/4/062015RS.TRAUMA CENTRE 01/06/2015 31/05/2016

104 1500000001777 PUSKESMAS PAGERUYUNG DS PUCAKWANGI PAGERUYUNG 51361 5790987 DR SULASIH PER/15-04/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

105 1500000001752 PUSKESMAS PANDANARAN JL PANDANARAN NO 79 SEMARANG 50144 8311470 DR ANTONIA S PER/16-29/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

106 1500000001752 PUSKESMAS PANDANARAN JL PANDANARAN NO 79 SEMARANG 50144 8311470 DR ANTONIA SPER/14/29/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

107 1500000001760 PUSKESMAS PATEANJL SUKOREJO PARAKAN KM 4 PAGERSARI PATEAN 51364 451531

MOH JAMALUDHIN SKM MM PER/15/5/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

108 1500000001760 PUSKESMAS PATEANJL SUKOREJO PARAKAN KM 4 PAGERSARI PATEAN

51364 451531MOH JAMALUDHIN SKM MM

PER/15-05/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

109 1500000001764 PUSKESMAS PATEBON 02 DS KEBONHARJO KEC PATEBON KENDAL 51351 3686051 DR ISTIQOMAH TRI HANDAYANI

PER/15/28/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


268 / 44607-11-201606:23:31



IKS


110 1500000001764 PUSKESMAS PATEBON 02 DS KEBONHARJO KEC PATEBON KENDAL 51351 3686051 DR ISTIQOMAH TRI HANDAYANI

PER/15-28/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

111 1500000001795 PUSKESMAS PATEBON 1 DS PIDODOKULON KEC PATEBON 51351 5790390 DR ULIA HUDA PER/15/27/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

112 1500000001795 PUSKESMAS PATEBON 1 DS PIDODOKULON KEC PATEBON 51351 5790390 DR ULIA HUDA PER/15-27/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

113 1500000001732 PUSKESMAS PEGANDAN JL KENDENG BARAT III / 2 SMG 50274 8445809 SRI ANIHANDAYANI SKMMKES

PER/16-15/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

114 1500000001732 PUSKESMAS PEGANDAN JL KENDENG BARAT III / 2 SMG 50274 8445809 SRI ANIHANDAYANI SKMMKES

PER/14/15/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

115 1500000001761 PUSKESMAS PEGANDON JL RAYA TEGOREJO PEGANDON 51357 383705 DR NUR WIDYASTUTIPER/15/11/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

116 1500000001761 PUSKESMAS PEGANDON JL RAYA TEGOREJO PEGANDON 51357 383705 DR NUR WIDYASTUTI PER/15-11/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

117 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

118 7-1445869188PUSKESMAS PENAWANGAN II

JL. RAYA SEDADI KM 3, KEC. PENAWANGAN 58161

DR. AGUS BUDI SARJONO, MM

PER/22-19/112015

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

119 1500000001776 PUSKESMAS PLANTUNGANJL RAYA NO 21 PLANTUNGAN DS TIRTOMULYO 51362 451714 DR BUDI MULYONO PER/15/1/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

120 1500000001776 PUSKESMAS PLANTUNGANJL RAYA NO 21 PLANTUNGAN DS TIRTOMULYO

51362 451714 DR BUDI MULYONOPER/15-01/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

121 1500000001763 PUSKESMAS PLT CEPIRING JL STASIUN SEMUT NO 9 CEPIRING 51352 383475 DR SRI INAYATI PER/15-24/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018


Periode : 01/01/2015 s/d 31/10/2016


269 / 44607-11-201606:23:31



IKS


122 1500000001763 PUSKESMAS PLT CEPIRING JL STASIUN SEMUT NO 9 CEPIRING 51352 383475 DR SRI INAYATI PER/15/24/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

123 1500000001717 PUSKESMAS PONCOL JL IMAM BONJOL NO 114 50132 3546053 DRG SUTANTI PER/14/1/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2017

124 1500000001742 PUSKESMAS PUDAK PAYUNG

JL PERINTIS KEMERDEKAAN SMG 50269 7462711 SUMARSONO SKM MKES PER/16-21/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

125 1500000001742 PUSKESMAS PUDAK PAYUNG

JL PERINTIS KEMERDEKAAN SMG 50269 7462711 SUMARSONO SKM MKES PER/14/21/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

126 7-1445943179 PUSKESMAS PULOKULON I JL. RAYA . PANUNGGALAN NO 137, KEC. PULOKULON 58181 081325129

862RIJADI AZIKIN, SKM, M.KES

PER/22-20/112015

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

127 7-1445969030 PUSKESMAS PULOKULON IIJL. DAYANG KUWU NO.18, KEC. PULOKULON 58181

DR. PUNGKI ADHITAMA P

PER/22-21/112015

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

128 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

129 7-1446286013 PUSKESMAS PURWODADI II DS. NAMBUHAN, KEC PURWODADI 58111 02927701414

DR. RINJANI SURYANINGSIH, MA

PER/22-23/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

130 1500000001748 PUSKESMAS PURWOYOSO JL SILIWANGI NO 572 SMG 50263 7612927DRS BUDI MULYONO MKES

PER/14/25/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

131 1500000001748 PUSKESMAS PURWOYOSO JL SILIWANGI NO 572 SMG 50263 7612927DRS BUDI MULYONO MKES

PER/16-25/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

132 1500000001780 PUSKESMAS RINGINARUM DS RINGINARUM KEC RINGINARUM 51356 5701268 DR ENDAH PUSPITORINIPER/15-15/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

133 1500000001780 PUSKESMAS RINGINARUM DS RINGINARUM KEC RINGINARUM 51356 5701268 DR ENDAH PUSPITORINI PER/15/15/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


270 / 44607-11-201606:23:31



IKS


134 1500000001738 PUSKESMAS ROWOSARI JL RAYA ROWOSARI NO 1 SMG 7019382 HERI WIBOWO SKM PER/14/19/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

135 1500000001738 PUSKESMAS ROWOSARI JL RAYA ROWOSARI NO 1 SMG 7019382 HERI WIBOWO SKM PER/16-19/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

136 1500000001757 PUSKESMAS ROWOSARI 02 KENDAL

JL RAYA SOEKARNO HATTA WONOTENGGANG KENDAL

51311 641541 DINAS KESEHATAN KAB KENDAL

PER/15-19/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

137 1500000001757 PUSKESMAS ROWOSARI 02 KENDAL

JL RAYA SOEKARNO HATTA WONOTENGGANG KENDAL

51311 641541 DINAS KESEHATAN KAB KENDAL

PER/15/19/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

138 1500000001779 PUSKESMAS ROWOSARI 1 DS SENDANG DAWUHAN KEC ROWOSARI 51354 5792354 DR YUNI WIDIASTUTI PER/15-18/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

139 1500000001779 PUSKESMAS ROWOSARI 1 DS SENDANG DAWUHAN KEC ROWOSARI 51354 5792354 DR YUNI WIDIASTUTIPER/15/18/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

140 1500000001744 PUSKESMAS SEKARAN JL RAMBUTAN NO 44 SEKARAN GUNUNGPATI SMG

70772838 DR LILIK FARIDAH PER/14/23/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

141 1500000001744 PUSKESMAS SEKARAN JL RAMBUTAN NO 44 SEKARAN GUNUNGPATI SMG

70772838 DR LILIK FARIDAH PER/16-23/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

142 1500000001773 PUSKESMAS SINGOROJO 1 JL NGAREANAK SINGOROJO 51382 572328 SUTRISNO SKEP NERS PER/15/6/062015RS.TRAUMA CENTRE 01/06/2015 31/05/2016

143 1500000001773 PUSKESMAS SINGOROJO 1 JL NGAREANAK SINGOROJO 51382 572328 SUTRISNO SKEP NERSPER/15-06/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

144 1500000001772 PUSKESMAS SINGOROJO 2JL RAYA BOJA KALIWUNGU KM 20 KERTOSARI SINGOROJO

51382 571928 DR DWI YULIAWATI PER/15/7/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

145 1500000001772 PUSKESMAS SINGOROJO 2 JL RAYA BOJA KALIWUNGU KM 20 KERTOSARI SINGOROJO

51382 571928 DR DWI YULIAWATI PER/15-07/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018


Periode : 01/01/2015 s/d 31/10/2016


271 / 44607-11-201606:23:31



IKS


146 1500000001741 PUSKESMAS SRONDOL JL SETIABUDI NO 209 SMG 50263 7472852 DR NOEGROHO EDY RIJANTO MKES

PER/14/33/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

147 1500000001741 PUSKESMAS SRONDOL JL SETIABUDI NO 209 SMG 50263 7472852 DR NOEGROHO EDY RIJANTO MKES

PER/16-33/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

148 1500000001759 PUSKESMAS SUKOREJO 01 JL BANARAN NO 4 SUKOREJO 51363 451314 DR MUKHAMMAD TOHA PER/15-02/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

149 1500000001759 PUSKESMAS SUKOREJO 01 JL BANARAN NO 4 SUKOREJO 51363 451314 DR MUKHAMMAD TOHA PER/15/2/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

150 1500000001775 PUSKESMAS SUKOREJO 2 JL SUKOREJO NGADIWARNO 51363 452104 DR I MADE ASTAWA PER/15/3/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

151 1500000001775 PUSKESMAS SUKOREJO 2 JL SUKOREJO NGADIWARNO 51363 452104 DR I MADE ASTAWAPER/15-03/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

152 1500000001747 PUSKESMAS TAMBAK AJI JL RAYA WALISONGO KM 9 SMG 8661743 DRG SAKINAH PER/14/24/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

153 1500000001747 PUSKESMAS TAMBAK AJI JL RAYA WALISONGO KM 9 SMG 8661743 DRG SAKINAH PER/16-24/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

154 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

155 7-1446533475PUSKESMAS TAWANGHARJO

JL. RAYA PURWODADI BLORA POJOK, KEC. TAWANGHARJO 58191 DRG. RENDRA M

PER/22-25/112015

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

156 7-1446647286 PUSKESMAS TEGOWANUJL. GATOT SUBROTO NO. 128, KEC. TEGOWANU

5816502925135150

DR. EKO TAKARIYANTOPER/22-26/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

157 1500000001736 PUSKESMAS TLOGOSARI KULON

JL TAMAN SATRIO MANAH NO 2 TLOGOSARI SMG

50196 6717051 DR INDAH WIDIASTUTI PER/16-31/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018


Periode : 01/01/2015 s/d 31/10/2016


272 / 44607-11-201606:23:31



IKS


158 1500000001736 PUSKESMAS TLOGOSARI KULON

JL TAMAN SATRIO MANAH NO 2 TLOGOSARI SMG 50196 6717051 DR INDAH WIDIASTUTI PER/14/31/06201

5RS.TRAUMA CENTRE 01/06/2015 31/05/2016

159 1500000001735 PUSKESMAS TLOGOSARI WETAN JL SOEKARNO HATTA SMG 50111 8713083 DR NURHAYATI MKES PER/14/17/06201

5RS.TRAUMA CENTRE 01/06/2015 31/05/2016

160 1500000001735 PUSKESMAS TLOGOSARI WETAN

JL SOEKARNO HATTA SMG 50111 8713083 DR NURHAYATI MKES PER/16-17/062016

RS.TRAUMA CENTRE

25/08/2016 31/12/2018

161 7-1446759157 PUSKESMAS TOROH I JL. RAYA SOLO 171 DS. DEPOK, KEC. TOROH 58171 0292552192

AGUS SETIJORINI, SKM PER/22-27/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

162 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

163 1500000001766 PUSKESMAS WELERI 02 DS KARANGANOM KEC WELERI 51355 643245TEGUH PRASOJO AMD KEP

PER/15-17/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

164 1500000001766 PUSKESMAS WELERI 02 DS KARANGANOM KEC WELERI 51355 643245 TEGUH PRASOJO AMD KEP

PER/15/17/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

165 1500000001778 PUSKESMAS WELERI 1 JL TAMTAMA NO 3 WELERI 51355 641023 DR SRI JOKO PITOYO PER/15/16/062015

RS.TRAUMA CENTRE

01/06/2015 31/05/2016

166 1500000001778 PUSKESMAS WELERI 1 JL TAMTAMA NO 3 WELERI 51355 641023 DR SRI JOKO PITOYOPER/15-16/062016

RS.TRAUMA CENTRE 25/08/2016 31/12/2018

167 7-1446854619 PUSKESMAS WIROSARI I JL. KUSUMA BANGSA, KEC. WIROSARI 581920292761029 DJAKA WIDADA B, SKM 445/1722/2014

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

168 7-1446890010 PUSKESMAS WIROSARI IIJL TAMBAK NO. 1 DS. KARANG ASEM, KEC. WIROSARI

58192 SUTRISNO, SKMPER/22-30/112015

RS.TRAUMA CENTRE

18/01/2016 31/12/2016

169 1400000000218 RS BHAKTI WIRA TAMTAMA JL DR SOETOMO NO 17 3555944 PER/017/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


273 / 44607-11-201606:23:31



IKS


170 1400000000218 RS BHAKTI WIRA TAMTAMA JL DR SOETOMO NO 17 3555944 PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

171 7-953735513 RS COLUMBIA ASIA SEMARANG JL SILIWANGI NO 143 SEMARANG 50131 PT BELEFINA SARANA


172 7-4010676150 RS HERMINA BANYUMANIK SEMARANG

JL JEN POL ANTON SUDJARWO 195 A 50264 73488989 MEDIKA LOKA BANYUMANIK PT


01/07/2016 31/12/2018

173 1500000000212 RS ISLAM KENDAL JL AR RAHMAH NO 17 WELERI KENDAL 641870 DRG EDI SUMARWANTO MM MH KES


01/01/2016 31/12/2016

174 1500000000212 RS ISLAM KENDAL JL AR RAHMAH NO 17 WELERI KENDAL 641870 DRG EDI SUMARWANTO MM MH KES PER/022/022015 RS.TRAUMA

CENTRE 01/02/2015 31/12/2015

175 1500000001046RS MUHAMMADIYAH GUBUG JL LETJEN R SOEPRAPTO NO 12 GUBUG 533102 DR M ARIF RIDA PER/09/052015

RS.TRAUMA CENTRE 11/05/2015 10/05/2016

176 1500000001046 RS MUHAMMADIYAH GUBUG

JL LETJEN R SOEPRAPTO NO 12 GUBUG 533102 DR M ARIF RIDA PER/16/052016 RS.TRAUMA CENTRE

11/07/2016 31/12/2018

177 1500000000223 RS PANTI RAHAYU YAKKUMPURWODADI

JL LET JEND. R SUPRAPTO 06 PURWODADI 421087 DR SUNARIMA, M.KES PER/024/022015 RS.TRAUMA CENTRE

01/01/2015 31/12/2016

178 1500000001404RS PANTIWILASA DR CIPTO SEMARANG JL DR CIPTO NO 50 SEMARANG 3546040 YAKKUM PER/16/062016

RS.TRAUMA CENTRE 11/07/2016 31/12/2018

179 1500000001404RS PANTIWILASA DR CIPTO SEMARANG JL DR CIPTO NO 50 SEMARANG 3546040 YAKKUM PER/11/062015

RS.TRAUMA CENTRE 04/06/2015 03/06/2016

180 1400000000217 RS PELITA ANUGERAHJL RAYA BANDUNGREJO KM 11.5 MRANGGEN

6725555 LIDIA MEGAWATI PER/23/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

181 1400000000217 RS PELITA ANUGERAH JL RAYA BANDUNGREJO KM 11.5 MRANGGEN

6725555 LIDIA MEGAWATI PER/020/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


274 / 44607-11-201606:23:31



IKS


182 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

183 1400000000219 RS PERMATA MEDIKA JL MOCH ICHSAN NO 93-97 NGALIYAN 7625005 PER/019/122014 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

184 1400000000219 RS PERMATA MEDIKA JL MOCH ICHSAN NO 93-97 NGALIYAN 7625005 PER/24/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

185 1500000000648RS ROEMANI MUHAMMADIYAH SEMARANG

JL WONODRI 22 SEMARANG 8444623 PROF.DR.DR.H.RIFKI MUSLIM,SPB,SPU


01/04/2015 31/03/2017

186 1500000000693 RS ST ELISABETH SEMARANG JL KAWI NO 1 SEMARANG 8310035 YAYASAN RS ST

ELISABETH PER/027/042015 RS.TRAUMA CENTRE 20/04/2015 19/04/2016

187 1500000000693RS ST ELISABETH SEMARANG JL KAWI NO 1 SEMARANG 8310035

YAYASAN RS ST ELISABETH PER/10/042016

RS.TRAUMA CENTRE 10/06/2016 31/12/2018

188 1500000001247 RS TELOGOREJO JL KHA DAHLAN SEMARANG 8446000YAYASASAN KESEHATAN TELOGOREJO


19/05/2015 18/05/2017

189 7-4122177096RSJ DAERAH DR. AMINO GONDOHUTOMO SEMARANG

JL BRIGJEND S. SUDIARTO NO. 347 50113 6722564 PEMDA PROV JATENG PER/11/052016 RS.TRAUMA CENTRE

25/07/2016 31/12/2018

190 1500000000773RSU WILLIAM BOOTH SEMARANG JL LETJEND S PARMAN NO 5 SEMARANG 8411800

YAYASAN BALA KESELAMATAN PER/07/042015

RS.TRAUMA CENTRE 30/04/2015 31/03/2016

191 1500000000773RSU WILLIAM BOOTH SEMARANG JL LETJEND S PARMAN NO 5 SEMARANG 8411800

YAYASAN BALA KESELAMATAN PER/08/042016

RS.TRAUMA CENTRE 10/06/2016 31/12/2018

192 1500000000222RSUD DR H SOEWONDO KENDAL

JL LAUT NO.21 KENDAL 381433DR SRI MULYANI, SP.A, M.KES


01/02/2015 31/01/2017

193 1500000000211 RSUD DR R SOEDJATI SOEMODIARDJO

JL DI PANJAITAN 36 PURWODADI 421004 DR BAMBANG PUJIYANTO M.KES


16/02/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


275 / 44607-11-201606:23:31



IKS


194 1500000000211 RSUD 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

195 1400000000216 RSUD KOTA SEMARANG JL FATMAWATI NO 1 SEMARANG 6711500 PER/29/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

196 1400000000216 RSUD KOTA SEMARANG JL FATMAWATI NO 1 SEMARANG 6711500 PER/018/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

197 1400000000214 RSUD TUGUREJO JL. RAYA TUGUREJO KM 9 TAMBAK AJI NGALIYAN


01/01/2016 31/12/2016

198 1400000000214 RSUD TUGUREJO JL. RAYA TUGUREJO KM 9 TAMBAK AJI NGALIYAN 7605297 PER/016/122014 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

199 7-337195525RSUP DR KARIADI SEMARANG JL DR SUTOMO 16 SEMARANG 50245

0248413993

KEMENTERIAN KESEHATAN RI PER/13/062015

RS.TRAUMA CENTRE 13/11/2015 31/05/2016

200 7-337195525 RSUP DR KARIADI SEMARANG

JL DR SUTOMO 16 SEMARANG 50245 0248413993

KEMENTERIAN KESEHATAN RI


25/08/2016 31/12/2018

KANTOR CABANG : L01- KANTOR CABANG SURAKARTA


IKS


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

6499639DR HADIASRI WIDIYASARI


11/01/2016 31/12/2016

2 1500000000142 KLINIK GRIYA HUSADA 1 JL. MEKARSARI RT 03 RW 01 POPONGAN KARANGANYAR

6499639 DR HADIASRI WIDIYASARI


01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


276 / 44607-11-201606:23:31



IKS


3 1500000000143 KLINIK GRIYA HUSADA 2 SURUH KALONG PANDEYAN TASIKMADU RT 1/ RW 7 KARANGANYAR 9726555 DR ITA KUSUMAWATI PER/16/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

4 1500000000143 KLINIK GRIYA HUSADA 2 SURUH KALONG PANDEYAN TASIKMADU RT 1/ RW 7 KARANGANYAR 9726555 DR ITA KUSUMAWATI PER/16/012016 RS.TRAUMA

CENTRE 15/03/2016 31/12/2016

5 1500000000144 KLINIK GRIYA HUSADA 4 JL SOLO PURWODADI KM 6 GONDANGREJO KARANGANYAR

29726555 CV GRIYA DAYA MANDIRI


15/03/2016 31/12/2016

6 1500000000144 KLINIK GRIYA HUSADA 4 JL SOLO PURWODADI KM 6 GONDANGREJO KARANGANYAR

29726555 CV GRIYA DAYA MANDIRI


01/01/2015 31/12/2015

7 7-3614914763 KLINIK MITRA SEHAT JL LAWU BARAT NO. 183 PAPAHAN KARANGANYAR 57722 27838050 DR DEWI KOMALASARI PER/46/052016 RS.TRAUMA

CENTRE 02/06/2016 31/12/2018

8 1500000001791KLINIK NAYAKA HUSADA 07KARANGANYAR

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


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

9 1500000001791 KLINIK NAYAKA HUSADA 07KARANGANYAR

JL RAYA SOLO SRAGEN KM 10 DAWUNG RT02/01 DESA KEMIRI KEBAKKRAMAT



01/07/2015 31/12/2015

10 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

11 1500000001215KLINIK NGESTI HUSADA JATI JL SUMPAH PEMUDA NO. G KADIPIRO DR DEVI FIKASARI PER/33/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

12 1400000000516 KLINIK NGUDI SEHATJL. TENTARA PELAJAR NO. 31 SANGGRAHAN GROGOL SUKOHARJO 2974269 SUHADI PER/18/012016

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

13 1500000000106KLINIK NGUDI SEHAT PARANGJORO

SINGKIL RT 03 RW 08 PARANGJORO GROGOL SUKOHARJO

2974269KLINIK NGUDI SEHAT PARANGJORO


01/01/2015 31/12/2015

14 1500000000106 KLINIK NGUDI SEHAT PARANGJORO

SINGKIL RT 03 RW 08 PARANGJORO GROGOL SUKOHARJO

2974269 KLINIK NGUDI SEHAT PARANGJORO


11/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


277 / 44607-11-201606:23:31



IKS


15 1500000000417 KLINIK NURIFA JL SLAMET RIYADI KARTASURA SUKOHARJO ( KIOS PASAR BUMI REJO ) 2601843 DR UMI ARIFAH PER/24/032015 RS.TRAUMA

CENTRE 01/03/2015 31/12/2015

16 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

17 7-4944456643 KLINIK PRATAMA HARAPANSEHAT

PENDEK RT 04 RW 04 DESA MOJOGEDANG KARANGANYAR

57716 47461986 DR KIKI DWI QA PER/54/092016 RS.TRAUMA CENTRE

27/09/2016 31/12/2018

18 7-2885229574 KLINIK PRATAMA IIS MEDIKA

JL SLAMET RIYADI 156 KARTASURA SUKOHARJO

57161 08128792900

CV CHAFAZKA INSAN MULIA


13/04/2016 31/12/2018

19 7-2883966473 KLINIK PRATAMA SARI SEHAT JATI RT 03/02 JATEN KARANGANYAR 57731 91021574 DR SRI HARTINI [PER/41/042016 RS.TRAUMA

CENTRE 13/04/2016 31/12/2018

20 7-3073245233 KLINIK TEDUHJL. SUWARNO HONGGOPATI JLOGO GEDANGAN GROGOL SUKOHARJO 57552

666599812556

YAYASAN PANTI KOSALA PER/45/042016

RS.TRAUMA CENTRE 02/05/2016 31/12/2018

21 7-4192715713 PT KUSPITO ORTOTIK PROSTETIK

BULU JATEN KARANGANYAR 57731 RACHMAD WINARNO PER/49/062016 RS.TRAUMA CENTRE

28/07/2016 31/12/2018

22 1100000000030 PUSKESMAS KEBAKKRAMAT

JL RAYA SOLO- SRAGEN KM 12 825812 PER/01/012016 RS.TRAUMA CENTRE

15/03/2016 31/12/2016

23 1100000000030PUSKESMAS KEBAKKRAMAT JL RAYA SOLO- SRAGEN KM 12 825812 PER/01/012015

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

24 1400000000474 RS DR OEN SOLO BARU PERUMAHAN SOLO BARU GROGOL 620220 RS DR OEN SOLO BARU PER/07/012015RS.TRAUMA CENTRE 01/01/2015 31/12/2015

25 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

26 1100000000033 RS DR OEN SURAKARTA JL. BRIGJEND KATAMSO 55 643139 YYS PANTI KOSALA PER/12/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


278 / 44607-11-201606:23:31



IKS


27 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

28 1500000001866 RS HERMINA SOLO JL KOL SUTARTO NO. 16 RT 01/02 JEBRES SURAKARTA 57116 638989 PT MEDIKA LOKA SOLO PER/37/072015 RS.TRAUMA

CENTRE 01/07/2015 31/12/2015

29 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

30 1100000000034 RS KASIH IBU SURAKARTA JL SLAMET RIYADI 404 714422 YYS KASIH IBU PER/09/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

31 1500000001873 RS KHUSUS BEDAH KARIMAUTAMA SURAKARTA

JL. AMARTA RAYA 8-10 TERMINAL BARU NGABEYAN KARTASURA 783399 PT. KARIMA UTAMA

SEJAHTERA PER/38/072015 RS.TRAUMA CENTRE 01/07/2015 31/12/2015

32 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

33 1100000000032 RS KUSTATI JL KAPT MULYADI 249 643013 PER/10/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

34 1100000000032 RS KUSTATI JL KAPT MULYADI 249 643013 PER/09/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

35 1500000001009 RS LANUD ADI SOEMARMOJL TENTARA PELAJAR MALANGJIWAN COLOMADU 780240 TNI AU SURAKARTA PER/32/052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

36 1500000001009 RS LANUD ADI SOEMARMOJL TENTARA PELAJAR MALANGJIWAN COLOMADU 780240 TNI AU SURAKARTA PER/26/012016

RS.TRAUMA CENTRE 15/03/2016 31/12/2016

37 7-2461866504RS MEDIKA MULYA WONOGIRI

JL WONOGIRI - NGADIROJO KM 5 WONOGIRI

57652YAYASAN RS MEDIKA MULYA


15/03/2016 31/12/2016

38 7-2875438383 RS MULIA HATI WONOGIRI JL RM SAID BRUMBUNG KALIANCAR SELOGIRI

57652 PT MULIA SURGICA WONOGIRI


13/04/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


279 / 44607-11-201606:23:31



IKS


39 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

40 1100000000035 RS ORTHOPEDI PROF DR SOEHARSO JL. JEND A YANI PABELAN 714458 PER/02/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

41 1100000000031 RS PANTI WALUYO JL A YANI 1-2 712077 PER/39/082015 RS.TRAUMA CENTRE

01/08/2015 31/12/2015

42 1100000000031 RS PANTI WALUYO JL A YANI 1-2 712077 PER/15/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

43 1500000000294 RS PKU MUHAMADIYAH SELOGIRI

JL LAMA NAMBANGAN SELOGIRI WONOGIRI 5327504 YYS PKU

MUHAMADIYAH PER/21/012016 RS.TRAUMA CENTRE 11/01/2016 31/12/2016

44 1500000000294RS PKU MUHAMADIYAH SELOGIRI

JL LAMA NAMBANGAN SELOGIRI WONOGIRI 5327504

YYS PKU MUHAMADIYAH PER/22/032015

RS.TRAUMA CENTRE 01/03/2015 31/12/2015

45 1400000000537 RS PKU MUHAMADIYAH SURAKARTA

JL RONGGOWARSITO NO 130 SURAKARTA 714578 RS PKU MUHAMADIYAH SURAKARTA


11/01/2016 31/12/2016

46 1500000001946 RS PKU MUHAMMADIYAH KARANGANYAR

JL PAPAHAN DESA PAPAHAN KECAMATAN TASIKMADU

57171 492685 YAYASAN MUHAMADIYAH


01/08/2015 31/12/2015

47 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

48 1500000001628RS PKU MUHAMMADIYAH SRAGEN

JL RAYA SOLO SRAGEN KM 8 MASARAN SRAGEN

YAYASAN MUHAMADIYAH PER/17/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

49 1500000001628RS PKU MUHAMMADIYAH SRAGEN

JL RAYA SOLO SRAGEN KM 8 MASARAN SRAGEN

YAYASAN MUHAMADIYAH


01/01/2016 31/12/2016

50 1500000001531 RSI AMAL SEHAT SRAGEN JL VETERAN NO 35 SRAGEN YAYASAN AMAL SEHAT SRAGEN


15/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


280 / 44607-11-201606:23:31



IKS


51 1500000001531 RSI AMAL SEHAT SRAGEN JL VETERAN NO 35 SRAGEN YAYASAN AMAL SEHAT SRAGEN PER/18/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

52 7-4401434814 RSIA DIAN PERTIWI KODOKAN RT 02 RW 01 PAPAHAN TASIKMADU KARANGANYAR 57721 623459455 DR JAYA MASSA, SPOG PER/50/072016 RS.TRAUMA

CENTRE 18/08/2016 31/12/2017

53 7-1689398627 RSO PROF DR R SOEHARSO SURAKARTA

JL A AYANI KARTASURA 50771 71445832 KEMENKES PER/02/012016 RS.TRAUMA CENTRE

29/01/2016 31/12/2016

54 7-2888512933 RSU INDO SEHAT JL. RAYA SOLO SRAGEN KM 11 KEBAKKRAMAT

57762 YAYASAN INDO SEHAT PER/42/042016 RS.TRAUMA CENTRE

13/04/2016 31/12/2018

55 1500000000121 RSU JATI HUSADA KARANGANYAR

JL RAYA SOLO TAWANGMANGU KM 10,3 JATI JATEN KARANGANYAR

PT TENTERAM MAKMUR BERSAMA PER/13/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

56 1500000000121RSU JATI HUSADA KARANGANYAR

JL RAYA SOLO TAWANGMANGU KM 10,3 JATI JATEN KARANGANYAR

PT TENTERAM MAKMUR BERSAMA PER/11/012016

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

57 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

58 1500000000687 RSU MARDI LESTARI JL ROKAN NO 8 SRAGEN YYS SANTA KATARINA L PER/27/042015 RS.TRAUMA CENTRE

01/04/2015 31/12/2015

59 1100000000036RSUD DR MOEWARDI SURAKARTA JL KOL SUTARTO 132 634634 PER/03/012016

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

60 1100000000036RSUD DR MOEWARDI SURAKARTA JL KOL SUTARTO 132 634634 PER/03/012015

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

61 7-3265778097RSUD DR SOEDIRAN MANGUN SUMARSO KABUPATEN WONOGIRI

JL A YANI NO 40 WONOGIRI 57611 PEMKAB WONOGIRI PER/34/012016RS.TRAUMA CENTRE

10/05/2016 31/12/2016

62 1500000000120 RSUD DR SOEHADI PRIJONEGORO SRAGEN

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

11/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


281 / 44607-11-201606:23:31



IKS


63 1500000000120 RSUD DR SOEHADI PRIJONEGORO SRAGEN JL RAYA SUKOWATI 534 SRAGEN PER/14/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

64 1400000000424 RSUD KABUPATEN KARANGANYAR JL. LAKSDA YOS SUDARSO 495673 RSUD KABUPATEN

KARANGANYAR PER/04/012016 RS.TRAUMA CENTRE 11/01/2016 31/12/2016

65 1400000000424 RSUD KABUPATEN KARANGANYAR

JL. LAKSDA YOS SUDARSO 495673 RSUD KABUPATEN KARANGANYAR


01/01/2015 31/12/2015

66 1400000000425 RSUD KABUPATEN SUKOHARJO

JL DR MOEWARDI 71 SUKOHARJO 593118 RSUD KABUPATEN SUKOHARJO


01/01/2015 31/12/2015

67 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

68 1400000000423 RSUD KOTA SURAKARTAJL. LETTU SUMARTO NOMOR : 1 KADIPIRO BANJARSARI 715300 RSUD KOTA SURAKARTA PER/06/012015

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

69 1400000000423 RSUD KOTA SURAKARTA JL. LETTU SUMARTO NOMOR : 1 KADIPIRO BANJARSARI

715300 RSUD KOTA SURAKARTA PER/06/012016 RS.TRAUMA CENTRE

29/01/2016 31/12/2016

70 7-2461234733 RUMAH SAKIT BRAYAT MINULYA

JL SETIA BUDI 106 57139 71664624632

YAYASAN RS BRAYAT MINULYA


15/03/2016 31/12/2016

71 7-3070677308RUMAH SAKIT JIWA DAERAH SURAKARTA

JL KH DEWANTORO NO. 80 JEBRES SURAKARTA 57121

PEMERINTAH PROPINSI JATENG PER/44/042016

RS.TRAUMA CENTRE 02/05/2016 31/12/2018

72 7-2610514586RUMAH SAKIT MARGA HUSADA JL LETJEND S PARMAN WONOGIRI 57652 32194455

RS MARGA HUSADA WONOGIRI PER/39/032016

RS.TRAUMA CENTRE 28/03/2016 31/12/2016

73 1500000000458RUMAH SAKIT SARILA HUSADA

JL VETERAN NO. 41 - 43 SRAGEN 29697090 RS SARILA HUSADA PER/25/032015RS.TRAUMA CENTRE

01/03/2015 31/12/2015

74 7-2519970682 RUMAH SAKIT SARILA HUSADA

JL VETERAN NO. 41-43 SRAGEN 57211 89119400 PT SARILA HUSADA PER/23/012016 RS.TRAUMA CENTRE

15/03/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


282 / 44607-11-201606:23:31



IKS


75 7-2510145183 RUMAH SAKIT UMUM ISLAM YAKSSI GEMOLONG JL SOLO PURWODADI KM 20 57274 YAYASAN YAKSSI

GEMOLONG PER/38/022016 RS.TRAUMA CENTRE 15/03/2016 31/12/2016

KANTOR CABANG : L02- KANTOR CABANG CILACAP


IKS


1 7-3770596713 KLINIK BINA HUSADA I JL. PUCANG NO. 90 KEL GUMILIR KEC CILACAP UTARA 53231 62611300 H. SUWONDO. M. SI PER/12/062016 RS.TRAUMA

CENTRE 14/06/2016 31/12/2017

2 1500000001026 KLINIK DAARUSSYIFAJL. MERPATI NO. 9 RT 02 RW 02 DESA SLARANG KEC KESUGIHAN 53274 5263311 DR TAUFIQ HIDAYAT PER/12/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

3 1500000001026 KLINIK DAARUSSYIFA JL. MERPATI NO. 9 RT 02 RW 02 DESA SLARANG KEC KESUGIHAN

53274 5263311 DR TAUFIQ HIDAYAT PER/16/062016 RS.TRAUMA CENTRE

14/06/2016 31/12/2017

4 1500000000703 KLINIK GRAHA AMANAH JL. RAJAWALI NO. 328 RT 03 RW 02 DESA KARANGRENA KEC MAOS

53272 5501687 ARIS NUR RAHMAT PER/08/052016 RS.TRAUMA CENTRE

17/05/2016 31/12/2017

5 1500000000703 KLINIK GRAHA AMANAHJL. RAJAWALI NO. 328 RT 03 RW 02 DESA KARANGRENA KEC MAOS 53272 5501687 ARIS NUR RAHMAT PER/06/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

6 7-2832594183 KLINIK HAMADAJL. KENDENG NO. 43 RT 001 RW 004 DESA KURIPAN KEC KESUGIHAN KAB CILACAP 53274

EKO PRIYO ATMOJO, S.KEP.NS PER/03/042016

RS.TRAUMA CENTRE 07/04/2016 31/12/2017

7 7-4185904119 KLINIK INDIRAJL. KOMODO RT 01 RW 014 KEL MERTASINGA KEC CILACAP UTARA

5323108122733794

TURMUDI, S.ST, SKM PER/19/07/2016RS.TRAUMA CENTRE

28/07/2016 31/12/2017

8 1500000001675 KLINIK KELUARGA JL. TENTARA PELAJAR DESA JATINEGARA RT 05 RW 02 KEC SEMPOR

54352 5522836 DR AGUS SAPARIYANTO PER/20/072016 RS.TRAUMA CENTRE

28/07/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


283 / 44607-11-201606:23:31



IKS


9 1500000001675 KLINIK KELUARGA JL. TENTARA PELAJAR DESA JATINEGARA RT 05 RW 02 KEC SEMPOR 54352 5522836 DR AGUS SAPARIYANTO PER/20/072015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

10 1500000000550 KLINIK NAYAKA HUSADA JL. KOMPENI NO. 25 PIPA TIMUR 53221 532149 PT NAYAKA ERA HUSADA PER/03/042015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

11 1500000000550 KLINIK NAYAKA HUSADA JL. KOMPENI NO. 25 PIPA TIMUR 53221 532149 PT NAYAKA ERA HUSADA


19/04/2016 31/12/2017

12 1500000001705 KLINIK PKU MUHAMMADIYAH ADIPALA

JL. BALAI DESA RT 04 RW 05 DESA PENGGALANG KEC ADIPALA

53271 08122712670

YAYASAN PKU MUHAMMADIYAH


28/07/2016 31/12/2017

13 1500000001705 KLINIK PKU MUHAMMADIYAH ADIPALA

JL. BALAI DESA RT 04 RW 05 DESA PENGGALANG KEC ADIPALA 53271 081227126

70YAYASAN PKU MUHAMMADIYAH PER/21/072015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

14 1500000001057KLINIK PKU MUHAMMADIYAH CILACAP

JL. KUTILANG TIMUR NO. 174 RT 01 RW 05 DESA TEGALREJA KEC. CILACAP SELATAN 53212 521208

YAYASAN PKU MUHAMMADIYAH CILACAP SELATAN


15 1500000001057 KLINIK PKU MUHAMMADIYAH CILACAP

JL. KUTILANG TIMUR NO. 174 RT 01 RW 05 DESA TEGALREJA KEC. CILACAP SELATAN

53212 521208YAYASAN PKU MUHAMMADIYAH CILACAP SELATAN


01/06/2015 31/05/2016

16 1500000001228 KLINIK PKU MUHAMMADIYAH KROYA

JL. RAYA MUJUR - KROYA TROMOL POS 02 KEC. KROYA

53282 494993YAYASAN PKU MUHAMMADIYAH KROYA


14/06/2016 31/12/2017

17 1500000001228KLINIK PKU MUHAMMADIYAH KROYA

JL. RAYA MUJUR - KROYA TROMOL POS 02 KEC. KROYA 53282 494993

YAYASAN PKU MUHAMMADIYAH KROYA


18 1500000001000KLINIK PKU MUHAMMADIYAH SAMPANG

JL. RAYA SAMPANG - KARANG TENGAH KM 2 SAMPANG 53273 5265565

PKU MUHAMMADIYAH SAMPANG - CILACAP PER/11/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

19 1500000001000KLINIK PKU MUHAMMADIYAH SAMPANG

JL. RAYA SAMPANG - KARANG TENGAH KM 2 SAMPANG

53273 5265565PKU MUHAMMADIYAH SAMPANG - CILACAP


14/06/2016 31/12/2017

20 1500000000865 KLINIK RAJA HUSADA JL. SRANDIL NO. 212 B RT 006 RW 011 DESA ADIRAJA KEC. ADIPALA

53271 5264443 DR HERI YULIADRI PER/13/062016 RS.TRAUMA CENTRE

14/06/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


284 / 44607-11-201606:23:31



IKS


21 1500000000865 KLINIK RAJA HUSADA JL. SRANDIL NO. 212 B RT 006 RW 011 DESA ADIRAJA KEC. ADIPALA 53271 5264443 DR HERI YULIADRI PER/09/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

22 1500000000762 RS PALANG BIRU GOMBONG JL. KARTINI NO. 37 GOMBONG 54411 471290YAYASAN SWANA SANTA PALANG BIRU GOMBONG KEBUMEN


23 1500000000762 RS PALANG BIRU GOMBONG JL. KARTINI NO. 37 GOMBONG 54411 471290YAYASAN SWANA SANTA PALANG BIRU GOMBONG KEBUMEN


17/05/2016 31/12/2017

24 1400000000491 RS PKU MUHAMMADIYAH GOMBONG

JL. YOS SUDARSO NO. 461 GOMBONG 54412 471780 DR. IBNU NASER A, S. AG,MMR


01/01/2016 31/12/2016

25 1500000000866 RS PKU MUHAMMADIYAH SRUWENG JL. RAYA SRUWENG NO. 5 KEC. SRUWENG 54362 382597

MUHAMMADIYAH CABANG SRUWENG, KEBUMEN


26 1500000000866RS PKU MUHAMMADIYAH SRUWENG JL. RAYA SRUWENG NO. 5 KEC. SRUWENG 54362 382597

MUHAMMADIYAH CABANG SRUWENG, KEBUMEN


27 1500000000733 RSU PERMATA MEDIKA KEBUMEN

JL. INDRAKILA NO. 17 54311 3870779 DRG. BUDI IRIANTO PER/09/052016 RS.TRAUMA CENTRE

17/05/2016 31/12/2017

28 1500000000733 RSU PERMATA MEDIKA KEBUMEN

JL. INDRAKILA NO. 17 54311 3870779 DRG. BUDI IRIANTO PER/07/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

29 1500000000431 RSU SANTA MARIA CILACAPJL. JEND. A. YANI NO. 38 KEL. SIDAKAYA KEC. CILACAP SELATAN 53211 521725 YAYASAN MEDIATRIX PER/04/042016

RS.TRAUMA CENTRE 19/04/2016 31/12/2017

30 1500000000431 RSU SANTA MARIA CILACAPJL. JEND. A. YANI NO. 38 KEL. SIDAKAYA KEC. CILACAP SELATAN 53211 521725 YAYASAN MEDIATRIX PER/02/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

31 1100000000021 RSUD CILACAP JL GATOT SUBROTO NO. 28 53224 533010DR. NONO RASINO, SP.OG(K)


01/01/2016 31/12/2016

32 1100000000021 RSUD CILACAP JL GATOT SUBROTO NO. 28 53224 533010 DR. NONO RASINO, SP.OG(K)

PER / 01 / 012015

RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


285 / 44607-11-201606:23:31



IKS


33 1500000000702 RSUD MAJENANG JL. DR. SUTOMO NO. 54 MAJENANG 53257 621012 RSUD MAJENANG PER/05/052015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

34 1500000000702 RSUD MAJENANG JL. DR. SUTOMO NO. 54 MAJENANG 53257 621012 RSUD MAJENANG PER/07/052016 RS.TRAUMA CENTRE 17/05/2016 31/12/2017

35 1500000000701 RUMAH SAKIT ISLAM FATIMAH

JL. IR. H. JUANDA NO. 20 53231 542396 YAYASAN RUMAH SAKITISLAM


01/05/2015 30/04/2016

36 1500000000701 RUMAH SAKIT ISLAM FATIMAH

JL. IR. H. JUANDA NO. 20 53231 542396 YAYASAN RUMAH SAKITISLAM


17/05/2016 31/12/2017

KANTOR CABANG : L03- KANTOR CABANG YOGYAKARTA


IKS


1 1500000000727 BLKPP DI YOGYAKARTA JLN KYAI MOJO NO. 5 YOGYAKARTA 512619 DISNAKERTRANS DIY PER/12/042016 RS.TRAUMA CENTRE

11/04/2016 28/02/2018

2 1500000000727 BLKPP DI YOGYAKARTA JLN KYAI MOJO NO. 5 YOGYAKARTA 512619 DISNAKERTRANS DIY PER/08/022015RS.TRAUMA CENTRE 01/03/2015 28/02/2016

3 1500000000400 BP PMI DI YOGYAKARTAJLN 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

4 1500000000400 BP PMI DI YOGYAKARTAJLN RING ROAD BARAT NO. 3, PATHUK, GAMPING, SLEMAN

6499652PMI PROP DI YOGYAKARTA


01/03/2015 28/02/2016

5 1500000000173 BP RB CITRA PARAMEDIKA GRAULAN RT 06 RW 03 GIRIPENI WATES 774876 YAYASAN BINANGUN CITRA PARA MEDIKA


01/02/2015 31/01/2016


Periode : 01/01/2015 s/d 31/10/2016


286 / 44607-11-201606:23:31



IKS


6 1500000000173 BP RB CITRA PARAMEDIKA GRAULAN RT 06 RW 03 GIRIPENI WATES 774876 YAYASAN BINANGUN CITRA PARA MEDIKA PER/10/042016 RS.TRAUMA

CENTRE 11/04/2016 31/01/2018

7 1500000001289 KLINIK CHANDRA BRATA MEDIKA PLAZA

TAMBAKAN RT 002 RW 019 SINDUHARJO NGAGLIK 882702 ANDRA BRATA MEDIKA

PLAZAPER/44/052016-II

RS.TRAUMA CENTRE 10/06/2016 31/12/2018

8 1500000001289 KLINIK CHANDRA BRATA MEDIKA PLAZA

TAMBAKAN RT 002 RW 019 SINDUHARJO NGAGLIK

882702 ANDRA BRATA MEDIKA PLAZA


01/06/2015 31/05/2016

9 1500000001334 KLINIK HARMONY GENDENG GK IV/969, BACIRO DR. ERNA PER/39/2015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

10 1500000001334 KLINIK HARMONY GENDENG GK IV/969, BACIRO DR. ERNA PER/45/052016-II

RS.TRAUMA CENTRE 10/06/2016 31/12/2018

11 1500000001238KLINIK HIPERKES DAN KESELAMATAN KERJA

JLN. IREDA NO.38, KEPARAKAN, MERGANGSAN BALAI HIPERKES

PER/21/052016-II

RS.TRAUMA CENTRE 10/06/2016 31/12/2018

12 1500000001238 KLINIK HIPERKES DAN KESELAMATAN KERJA

JLN. IREDA NO.38, KEPARAKAN, MERGANGSAN

BALAI HIPERKES PER/33/062015 RS.TRAUMA CENTRE

01/06/2015 01/05/2016

13 1500000001284 KLINIK LARAS HATI PRANCAK, GLONDONG, PANGGUNGHARJO, SEWON, BANTUL

RB LARAS HATI PER/36/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

14 1500000001284 KLINIK LARAS HATIPRANCAK, GLONDONG, PANGGUNGHARJO, SEWON, BANTUL RB LARAS HATI

PER/46/052016-II

RS.TRAUMA CENTRE 10/06/2016 31/12/2018

15 1500000001285KLINIK LARAS HATI KULON PROGO

WONOLOPO RT 33 RW 15, GULUREJO, LENDAH 55663

YAYASAN BHAKTI SOSIAL PER/35/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

16 1500000001285KLINIK LARAS HATI KULON PROGO

WONOLOPO RT 33 RW 15, GULUREJO, LENDAH

55663YAYASAN BHAKTI SOSIAL

PER/47/052016-II

RS.TRAUMA CENTRE

10/06/2016 31/12/2018

17 1500000001160 KLINIK PATALAN JLN. PARANG TRITIS KM 15, PATALAN, JETIS

DR GLORY PER/37/052016-II

RS.TRAUMA CENTRE

10/06/2016 31/12/2018


Periode : 01/01/2015 s/d 31/10/2016


287 / 44607-11-201606:23:31



IKS


18 1500000001160 KLINIK PATALAN JLN. PARANG TRITIS KM 15, PATALAN, JETIS DR GLORY PER/28/052015 RS.TRAUMA

CENTRE 28/05/2015 28/05/2016

19 1500000000598 KLINIK PRATAMA ANUGERAH

JLN RINDANG NO. 145, JADAN, TAMANTIRTO, KASIHAN 789670 DR. AR ROYAN PER/04/032015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

20 1500000000598 KLINIK PRATAMA ANUGERAH

JLN RINDANG NO. 145, JADAN, TAMANTIRTO, KASIHAN

789670 DR. AR ROYAN PER/16/042016 RS.TRAUMA CENTRE

11/04/2016 31/03/2018

21 1500000001237 KLINIK PRATAMA KARTIKA HUSADA

TEGALREJO NGLEGIS RT 05. SITIMULYO, BANTUL

PER/38/052016-II

RS.TRAUMA CENTRE

10/06/2016 31/12/2018

22 1500000001237 KLINIK PRATAMA KARTIKA HUSADA

TEGALREJO NGLEGIS RT 05. SITIMULYO, BANTUL PER/34/2015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

23 1500000000048KLINIK PRATAMA MITRA SEHAT

JL IMOGIRI TIMUR KM 6 DLADAN BARU NGLEBENG TAMANAN BANGUNTAPAN 9103190 CV MITRA SEHAT PER/01/012015

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

24 1500000000048 KLINIK PRATAMA MITRA SEHAT

JL IMOGIRI TIMUR KM 6 DLADAN BARU NGLEBENG TAMANAN BANGUNTAPAN

9103190 CV MITRA SEHAT PER/50/122015 RS.TRAUMA CENTRE

18/01/2016 31/12/2016

25 1500000000062 KLINIK PRATAMA SWA JL SALAK/TURI KM 4 KADISOBO II RT 02 RW03 TRIMULYO

7485660 YAYASAN SWA YOGYAKARTA


01/01/2015 31/12/2015

26 1500000000062 KLINIK PRATAMA SWAJL SALAK/TURI KM 4 KADISOBO II RT 02 RW03 TRIMULYO 7485660

YAYASAN SWA YOGYAKARTA PER/51/122015

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

27 1500000000063 KLINIK PRATAMA WIDURIJL MAGELANG KM 12 WIDORO TRIHARJO SLEMAN 867363 CV WIDURI PER/03/012015

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

28 1500000000063 KLINIK PRATAMA WIDURIJL MAGELANG KM 12 WIDORO TRIHARJO SLEMAN

867363 CV WIDURI PER/53/122015RS.TRAUMA CENTRE

18/01/2016 31/12/2016

29 1500000001669 KLINIK UTAMA BEDAH ADELIA

DONOLOYO IA KROBOKAN TAMANAN BANGUNTAPAN

4396680 TRIYONO PER/43/052016-II

RS.TRAUMA CENTRE

10/06/2016 31/12/2018


Periode : 01/01/2015 s/d 31/10/2016


288 / 44607-11-201606:23:31



IKS


30 1500000001669 KLINIK UTAMA BEDAH ADELIA

DONOLOYO IA KROBOKAN TAMANAN BANGUNTAPAN 4396680 TRIYONO PER/40/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

31 1500000001037 PUSKESMAS BAMBANGLIPURO

JL. SAMAS, SIDOMULYO, BAMBANGLIPURO, BANTUL 55764 027474938

09 DINKES BANTUL PER/23/082016 RS.TRAUMA CENTRE 28/05/2016 30/04/2018

32 1500000001037 PUSKESMAS BAMBANGLIPURO

JL. SAMAS, SIDOMULYO, BAMBANGLIPURO, BANTUL

55764 02747493809

DINKES BANTUL PER/17/052015 RS.TRAUMA CENTRE

28/05/2015 27/05/2016

33 1500000000399 PUSKESMAS BANGUNTAPAN 2

KROBOKAN DESA TAMANAN, BANGUNTAPAN , BANTUL

55191 02747466879

DINKES KAB BANTUL PER/10/042015 RS.TRAUMA CENTRE

11/04/2016 28/02/2018

34 1500000000399 PUSKESMAS BANGUNTAPAN 2

KROBOKAN DESA TAMANAN, BANGUNTAPAN , BANTUL 55191 027474668

79 DINKES KAB BANTUL PER/04/032015 RS.TRAUMA CENTRE 01/03/2015 28/02/2016

35 1500000001042 PUSKESMAS DLINGO I KORIPAN, DLINGO, BANTUL 55783DINAS KESEHATAN KABUPATEN BANTUL PER/21/052015

RS.TRAUMA CENTRE 28/05/2015 27/05/2016

36 1500000001042 PUSKESMAS DLINGO I KORIPAN, DLINGO, BANTUL 55783 DINAS KESEHATAN KABUPATEN BANTUL

PER/24/052016-II

RS.TRAUMA CENTRE

28/05/2016 31/12/2018

37 1500000001038 PUSKESMAS IMOGIRI 1 NGANCAR, KARANGTALUN, IMOGIRI, BANTUL

55782 02746994013


28/05/2016 30/04/2018

38 1500000001038 PUSKESMAS IMOGIRI 1NGANCAR, KARANGTALUN, IMOGIRI, BANTUL 55782

02746994013 DINKES BANTUL PER/19/052015

RS.TRAUMA CENTRE 28/05/2015 27/05/2016

39 1500000001067 PUSKESMAS JETIS 1 TELAN TRIMULY, JETIS BANTUL 5578102747466860 DINKES BANTUL PER/20/052015

RS.TRAUMA CENTRE 28/05/2015 27/05/2016

40 1500000001067 PUSKESMAS JETIS 1 TELAN TRIMULY, JETIS BANTUL 5578102747466860

DINKES BANTUL PER/26/052016RS.TRAUMA CENTRE

28/05/2016 30/04/2018

41 1500000001064 PUSKESMAS KASIHAN I NGENTAK, BANGUNJIWO, KASIHAAN 55181 DINAS KESEHATAN KABUPATEN BANTUL


28/05/2015 27/05/2016


Periode : 01/01/2015 s/d 31/10/2016


289 / 44607-11-201606:23:31



IKS


42 1500000001064 PUSKESMAS KASIHAN I NGENTAK, BANGUNJIWO, KASIHAAN 55181 DINAS KESEHATAN KABUPATEN BANTUL

PER/27/052016-II

RS.TRAUMA CENTRE 28/05/2016 31/12/2018

43 1500000000802 PUSKESMAS KRETEK JL PARANGTRITIS KM 21, SRUWUH, DONOTIRTO, KRETEK 55772 027436853

7 DINKES KAB BANTUL PER/28/052016-II

RS.TRAUMA CENTRE 25/05/2016 31/12/2018

44 1500000000802 PUSKESMAS KRETEK JL PARANGTRITIS KM 21, SRUWUH, DONOTIRTO, KRETEK

55772 0274368537

DINKES KAB BANTUL PER/11/052015 RS.TRAUMA CENTRE

08/05/2015 07/05/2016

45 1500000001049 PUSKESMAS PAJANGAN BEJI, SENDANGSARI, PAJANGAN, BANTUL 55751 710 1300 DINAS KESEHATAN KABUPATEN BANTUL


28/05/2015 27/05/2016

46 1500000001049 PUSKESMAS PAJANGAN BEJI, SENDANGSARI, PAJANGAN, BANTUL 55751 710 1300 DINAS KESEHATAN KABUPATEN BANTUL

PER/29/052016-II

RS.TRAUMA CENTRE 28/05/2016 31/12/2018

47 1500000001063 PUSKESMAS PANDAK I GESIKAN, WIJIREJO, PANDAK 5576102746462341

DINAS KESEHATAN KABUPATEN BANTUL PER/18/052015

RS.TRAUMA CENTRE 28/05/2015 27/05/2016

48 1500000001063 PUSKESMAS PANDAK I GESIKAN, WIJIREJO, PANDAK 55761 02746462341

DINAS KESEHATAN KABUPATEN BANTUL

PER/30/052016-II

RS.TRAUMA CENTRE

28/05/2016 31/12/2018

49 1500000001041 PUSKESMAS PIYUNGAN PAYAK, SRIMULYO, PIYUNGAN 55792 0274453218


28/05/2015 27/05/2016

50 1500000001041 PUSKESMAS PIYUNGAN PAYAK, SRIMULYO, PIYUNGAN 557920274453218 DINKES BANTUL PER/22/072016

RS.TRAUMA CENTRE 28/05/2016 30/04/2018

51 1500000001047 PUSKESMAS PLERET WONOKROMO, PLERET, BANTUL 5579102747466863 DINKES BANTUL

PER/31/052016-II

RS.TRAUMA CENTRE 10/06/2016 31/12/2018

52 1500000001047 PUSKESMAS PLERET WONOKROMO, PLERET, BANTUL 5579102747466863

DINKES BANTUL PER/22/052015RS.TRAUMA CENTRE

28/05/2015 27/05/2016

53 1500000001039 PUSKESMAS PUNDONG PIRING, SRIHARDONO, PUNDONG, BANTUL 55771 DINAS KESEHATAN BANTUL


28/05/2015 27/05/2016


Periode : 01/01/2015 s/d 31/10/2016


290 / 44607-11-201606:23:31



IKS


54 1500000001039 PUSKESMAS PUNDONG PIRING, SRIHARDONO, PUNDONG, BANTUL 55771 DINAS KESEHATAN BANTUL

PER/32/052016-II

RS.TRAUMA CENTRE 09/06/2016 31/12/2018

55 1500000001048 PUSKESMAS SANDEN PUCANGANOM, MURTIGADING, SANDEN 55763 02747104456 DINKES BANTUL PER/33/052016-

IIRS.TRAUMA CENTRE 10/06/2016 31/12/2018

56 1500000001048 PUSKESMAS SANDEN PUCANGANOM, MURTIGADING, SANDEN 55763 02747104456


28/05/2015 27/05/2016

57 1500000001066 PUSKESMAS SEDAYU 1 KEMUSUK, ARGOMULYO, SEDAYU 55752 0274747731

DINKES BANTUL PER/34/052016-II

RS.TRAUMA CENTRE

10/06/2016 31/12/2018

58 1500000001066 PUSKESMAS SEDAYU 1 KEMUSUK, ARGOMULYO, SEDAYU 55752 0274747731 DINKES BANTUL PER/26/052015 RS.TRAUMA

CENTRE 28/05/2015 27/05/2016

59 1500000000803 PUSKESMAS SEWON 1JLN. PARANGTRITIS KM 7, BANGI, TIMBULHARJO, SEWON 55185


RS.TRAUMA CENTRE 08/05/2015 07/05/2016

60 1500000000803 PUSKESMAS SEWON 1 JLN. PARANGTRITIS KM 7, BANGI, TIMBULHARJO, SEWON

55185 0274445550


RS.TRAUMA CENTRE

10/06/2016 31/12/2018

61 1500000000804 PUSKESMAS SRANDAKAN JL. RAYA SRANDAKAN, TRIMURTI, SRANDAKAN

55762 02746464815


RS.TRAUMA CENTRE

10/06/2016 31/12/2018

62 1500000000804 PUSKESMAS SRANDAKANJL. RAYA SRANDAKAN, TRIMURTI, SRANDAKAN 55762


RS.TRAUMA CENTRE 08/05/2015 07/05/2016

63 1400000000143 RS CONDONG CATURJL MANGGIS NO 6 GEMPOL CONDONG CATUR 887494

DR HERTI ELIZA SILALAHI PER/17/052016

RS.TRAUMA CENTRE 01/06/2016 31/05/2018

64 1400000000143 RS CONDONG CATURJL MANGGIS NO 6 GEMPOL CONDONG CATUR

887494DR HERTI ELIZA SILALAHI


01/06/2015 31/05/2016

65 1500000000447 RS ISLAM HIDAYATULLAH JLN. VETERAN NO. 184, PANDEYAN, UMBULHARJO

389184 PT. RSI HIDAYATULLAH PER/15/042016 RS.TRAUMA CENTRE

11/04/2016 31/03/2018


Periode : 01/01/2015 s/d 31/10/2016


291 / 44607-11-201606:23:31



IKS


66 1500000000447 RS ISLAM HIDAYATULLAH JLN. VETERAN NO. 184, PANDEYAN, UMBULHARJO 389184 PT. RSI HIDAYATULLAH PER/07/032015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

67 1400000000142 RS PANTI NUGROHO JL KALIURANG KM 17 895186 YAYASAN PANTI RAPIH PER/06/032015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

68 1400000000142 RS PANTI NUGROHO JL KALIURANG KM 17 895186 YAYASAN PANTI RAPIH PER/14/042016 RS.TRAUMA CENTRE

11/04/2016 31/03/2018

69 1500000000449 RS PANTI RINI JLN SOLO KM 13,2 KRAJAN, KALASAN, SLEMAN

496022 YAYASAN PANTI RAPIH PER/08/03/2015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

70 1500000000449 RS PANTI RINI JLN SOLO KM 13,2 KRAJAN, KALASAN, SLEMAN 496022 YAYASAN PANTI RAPIH PER/07/042016 RS.TRAUMA

CENTRE 06/04/2016 31/03/2018

71 1400000000005RS PKU MUHAMMADIYAH BANTUL JL. JEND SUDIRMAN NO.124 368238

YAYASAN MUHAMMADIYAH PER/45/122015

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

72 1400000000005 RS PKU MUHAMMADIYAH BANTUL

JL. JEND SUDIRMAN NO.124 368238 YAYASAN MUHAMMADIYAH


01/01/2015 31/12/2015

73 1400000000312 RS PKU MUHAMMADIYAH YOGYAKARTA

JL KHA DAHLAN 20 512653 YAYASAN MUHAMMADIYAH


01/05/2015 30/04/2016

74 1400000000312RS PKU MUHAMMADIYAH YOGYAKARTA JL KHA DAHLAN 20 512653

YAYASAN MUHAMMADIYAH PER/18/052016

RS.TRAUMA CENTRE 09/05/2016 30/04/2018

75 1400000000136 RS QUEEN LATIFAJL RING ROAD BARAT MLANGI NOGOTIRTOGAMPING 581402 PER/24/122014

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

76 1400000000136 RS QUEEN LATIFAJL RING ROAD BARAT MLANGI NOGOTIRTOGAMPING


18/01/2016 31/12/2016

77 1400000000139 RS RAJAWALI CITRA JL.PLERET KM 2,5 BANJARDADAP POTORONO BANGUNTAPAN BANTUL

7482003 DR H SUNU PRASMONO PER/30/062015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


292 / 44607-11-201606:23:31



IKS


78 1400000000139 RS RAJAWALI CITRA JL.PLERET KM 2,5 BANJARDADAP POTORONO BANGUNTAPAN BANTUL 7482003 DR H SUNU PRASMONO PER/19/042016 RS.TRAUMA

CENTRE 12/05/2016 30/04/2018

79 1500000001287RSKIA PKU MUHAMMADIYAH KOTAGEDE

JLN KEMASAN NO.43, PURBAYAN, KOTAGEDE MUHAMMADIYAH PER/39/052016-

IIRS.TRAUMA CENTRE 10/06/2016 31/12/2018

80 1500000001287RSKIA PKU MUHAMMADIYAH KOTAGEDE

JLN KEMASAN NO.43, PURBAYAN, KOTAGEDE

MUHAMMADIYAH PER/37/2015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

81 1400000000654 RSPAU DR S HARDJOLUKITO JALAN RAYA JANTI BLOK O 444715 TNI AU PER/50/102016 RS.TRAUMA CENTRE

03/10/2016 30/09/2018

82 1400000000654 RSPAU DR S HARDJOLUKITO JALAN RAYA JANTI BLOK O 444715 TNI AU PER/42/102015 RS.TRAUMA CENTRE 01/10/2015 30/09/2016

83 1500000001033 RSU AT-TUROST AL-ISLAMY JLN. KLACI I, MARGOLUWIH, SEYEGANYAYASAN MAJELIS AT-TUROST AL-ISLAMY

PER/40/052016-II

RS.TRAUMA CENTRE 10/06/2016 31/12/2018

84 1500000001033 RSU AT-TUROST AL-ISLAMY JLN. KLACI I, MARGOLUWIH, SEYEGAN YAYASAN MAJELIS AT-TUROST AL-ISLAMY


18/05/2015 18/04/2016

85 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

86 1500000000812RSU GRIYA MAHARDIKA YOGYAKARTA

JLN. PARANGTRITIS KM 4,5 GG. WIJAYAKUSUMA NO. 212, SEWON 445020 PT. RSGM PER/13/05/2015

RS.TRAUMA CENTRE 18/05/2015 17/05/2016

87 1500000000812RSU GRIYA MAHARDIKA YOGYAKARTA

JLN. PARANGTRITIS KM 4,5 GG. WIJAYAKUSUMA NO. 212, SEWON 445020 PT. RSGM PER/41/052016

RS.TRAUMA CENTRE 18/05/2016 30/04/2018

88 1400000000138 RSU KAB SLEMANJL BHAYANGKARA 48 MORANGAN SLEMAN

868437 PEMKAB BANTUL PER/13/042016RS.TRAUMA CENTRE

11/04/2016 31/03/2018

89 1400000000138 RSU KAB SLEMAN JL BHAYANGKARA 48 MORANGAN SLEMAN

868437 PEMKAB BANTUL PER/41/062015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016


Periode : 01/01/2015 s/d 31/10/2016


293 / 44607-11-201606:23:31



IKS


90 1500000000168 RSU KHARISMA PARAMEDIKA JL KHUDORI NO. 34 WATES 774633

YAYASAN BINANGUN KHARISMA PARAMEDIKA


91 1500000000168 RSU KHARISMA PARAMEDIKA JL KHUDORI NO. 34 WATES 774633

YAYASAN BINANGUN KHARISMA PARAMEDIKA


92 1500000000169 RSU MITRA SEHAT JL WATES KM. 9 BALECATUR GAMPING 6498555 PT EMPAT MITRA PER/07/012015 RS.TRAUMA CENTRE

01/02/2015 31/01/2016

93 1500000000169 RSU MITRA SEHAT JL WATES KM. 9 BALECATUR GAMPING 6498555 PT EMPAT MITRA PER/08/042016 RS.TRAUMA CENTRE

11/04/2016 31/01/2018

94 1500000000349 RSU PURI HUSADA JLN PALAGAN TENTARA PELAJAR KM 11 NO.67 SARIHARJO, NGAGLIK 867270 PT. HUSADA EDUKA

HOLISTIKA PER/02/012016 RS.TRAUMA CENTRE 01/02/2016 31/01/2017

95 1500000000349 RSU PURI HUSADAJLN PALAGAN TENTARA PELAJAR KM 11 NO.67 SARIHARJO, NGAGLIK 867270

PT. HUSADA EDUKA HOLISTIKA PER/02/012015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

96 1500000000858 RSU RACHMA HUSADA JLN PARANG TRITIS KM 16, PATALAN, JETIS, BANTUL

YAYASAN BINA MITRA HUSADA

PER/42/052016-II

RS.TRAUMA CENTRE

10/06/2016 31/12/2018

97 1500000000858 RSU RACHMA HUSADA JLN PARANG TRITIS KM 16, PATALAN, JETIS, BANTUL

YAYASAN BINA MITRA HUSADA


04/05/2015 03/05/2016

98 1500000000327 RSUD KOTA YOGYAKARTA JL WIROSABAN NO.1 YOGYAKARTA 371195 PEMKOT YOGYAKARTA PER/01/012016RS.TRAUMA CENTRE 01/02/2016 31/01/2017

99 1500000000327 RSUD KOTA YOGYAKARTA JL WIROSABAN NO.1 YOGYAKARTA 371195 PEMKOT YOGYAKARTA PER/04/012015RS.TRAUMA CENTRE 01/02/2015 31/01/2016

100 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

101 1500000000586 RSUP DR SARDJITO JLN KESEHATAN NO. 1, SEKIP, SINDUADI 587333 KEMENKES PER/06/042016 RS.TRAUMA CENTRE

04/04/2016 31/03/2017


Periode : 01/01/2015 s/d 31/10/2016


294 / 44607-11-201606:23:31



IKS


102 1500000000586 RSUP DR SARDJITO JLN KESEHATAN NO. 1, SEKIP, SINDUADI 587333 KEMENKES PER/09/042015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

103 1400000000479RUMAH SAKIT AKADEMIK UNIVERSITAS GADJAH MADA

JL KABUPATEN KRONGGAHAN TRIHANGGO GAMPING 4530404 UNIVERSITAS GADJAH

MADA PER/49/122015 RS.TRAUMA CENTRE 18/01/2016 30/11/2016

104 7-3896872113 RUMAH SAKIT HERMINA YOGYA

JL MATARAMAN HERMINA MAGUWOHARJO

55281 02742800808

PT MEDIKA LOKA YOGYA


22/06/2016 31/12/2018

105 1400000000315 RUMAH SAKIT ISLAM YOGYAKARTA PDHI

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


01/01/2015 31/12/2015

106 1400000000315 RUMAH SAKIT ISLAM YOGYAKARTA PDHI JL SOLO KM 12,5 KALASAN SLEMAN 498000 PROF.DR.DR.H

LAMSUDIN PER/47/122015 RS.TRAUMA CENTRE 11/04/2016 31/12/2016

107 7-3545728563RUMAH SAKIT JIWA GRHASIA DIY JL KALIURANG KM 17 PAKEM 55582

0274895143

PEMERINTAH DI YOGYAKARTA PER/48/042016

RS.TRAUMA CENTRE 30/05/2016 31/03/2018

108 1400000000480 RUMAH SAKIT LUDIRA HUSADA TAMA

JL WIRATAMA NO. 4 TEGALREJO 620333 DR BONDAN AGUS SURYANTO


18/01/2016 30/11/2016

109 1400000000695 RUMAH SAKIT NUR ROHMAH

JL WONOSARI-YOGYA KM 7 BANDUNG PLAYEN

394574 PT.RAHMA BAKTI HUSADA


18/01/2016 31/12/2016

110 1400000000695RUMAH SAKIT NUR ROHMAH

JL WONOSARI-YOGYA KM 7 BANDUNG PLAYEN 394574

PT.RAHMA BAKTI HUSADA PER/23/122014

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

111 1400000000696RUMAH SAKIT PANTI RAHAYU

JALAN WONOSARI-PONJONG KM 7 KELOR KARANGMOJO 392718 YAYASAN PANTI RAPIH PER/21/122014

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

112 1400000000696RUMAH SAKIT PANTI RAHAYU

JALAN WONOSARI-PONJONG KM 7 KELOR KARANGMOJO

392718 YAYASAN PANTI RAPIH PER/52/122015RS.TRAUMA CENTRE

18/01/2016 31/12/2016

113 1400000000134 RUMAH SAKIT PANTI RAPIH JALAN CIK DI TIRO NO 30 514014 YAYASAN PANTI RAPIH PER/20/052016 RS.TRAUMA CENTRE

09/06/2016 31/05/2018


Periode : 01/01/2015 s/d 31/10/2016


295 / 44607-11-201606:23:31



IKS


114 1400000000134 RUMAH SAKIT PANTI RAPIH JALAN CIK DI TIRO NO 30 514014 YAYASAN PANTI RAPIH PER/32/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

115 7-4394113363 RUMAH SAKIT PKU MUHAMMADIYAH GAMPING JL WATES KM 5,5 55291 027464997

04PERSYARIKATAN MUHAMMADIYAH PER/04/032016 RS.TRAUMA

CENTRE 16/08/2016 31/05/2018

KANTOR CABANG : L04- KANTOR CABANG PEKALONGAN


IKS


1 1500000001803KLINIK PRATAMA MARDLATILLAH JL RAYA PEMALANG RANDUDONGKAL 52361

PD MUHAMMADIYAH KABUPATEN PEMALANG

PER / 011 /052016

RS.TRAUMA CENTRE 01/07/2016 31/12/2017

2 1500000001803 KLINIK PRATAMA MARDLATILLAH

JL RAYA PEMALANG RANDUDONGKAL 52361 PD MUHAMMADIYAH KABUPATEN PEMALANG

PER / 015 / 062015

RS.TRAUMA CENTRE

01/07/2015 30/06/2016

3 7-3536620779 PUSKESMAS BOJONG I JL RAYA BOJONG NO 191 KEC BOJONG 51156 DINKES KAB PEKALONGAN

PER/005-16/052016

RS.TRAUMA CENTRE

26/05/2016 31/12/2017

4 7-3537018340 PUSKESMAS BOJONG II JL RAYA KALIPANCUR KEC BOJONG 51156DINKES KAB PEKALONGAN

PER/005-17/052016

RS.TRAUMA CENTRE 26/05/2016 31/12/2017

5 7-3538329145 PUSKESMAS BUARAN JL RAYA WONOYOSO NO 73 KEC BUARAN 51171DINKES KAB PEKALONGAN

PER/005-22/052016

RS.TRAUMA CENTRE 26/05/2016 31/12/2017

6 7-3502869508 PUSKESMAS DORO I JL A. YANI KEC. DORO 51191DINKES KAB PEKALONGAN

PER/005-6/052016

RS.TRAUMA CENTRE

24/05/2016 31/12/2017

7 7-3502885079 PUSKESMAS DORO II JL RAYA LARIKAN KEC.DORO 51191 DINKES KAB PEKALONGAN

PER/005-7/052016

RS.TRAUMA CENTRE

24/05/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


296 / 44607-11-201606:23:31



IKS


8 7-3502885721 PUSKESMAS KAJEN I JL RAYA DIPONEGORO NO 773 KEC KAJEN 51161 DINKES KAB PEKALONGAN

PER/005-9/052016

RS.TRAUMA CENTRE 24/05/2016 31/12/2017

9 7-3502885752 PUSKESMAS KAJEN II DS SOKOYOSO KEC. KAJEN 51161 DINKES KAB PEKALONGAN

PER/005-10/052016

RS.TRAUMA CENTRE 24/05/2016 31/12/2017

10 7-3502805603 PUSKESMAS KANDANGSERANG

JL RAYA KANDANGSERANG KEC.KANDANGSERANG

51163 DINKES KAB PEKALONGAN

PER/005-1/052016

RS.TRAUMA CENTRE

24/05/2016 31/12/2017

11 7-3502885410 PUSKESMAS KARANGANYAR

DS KARANG GONDANG KEC KARANG ANYAR


PER/005-8/052016

RS.TRAUMA CENTRE

24/05/2016 31/12/2017

12 7-3538219204 PUSKESMAS KARANGDADAP JL RAYA PEGADON KEC KARANGDADAP 51174 DINKES KAB

PEKALONGANPER/005-21/052016

RS.TRAUMA CENTRE 26/05/2016 31/12/2017

13 7-3537695212 PUSKESMAS KEDUNGWUNI IJL RAYA CAPGAWEN NO 104 KEC KEDUNGWUNI 51173

DINKES KAB PEKALONGAN

PER/005-19/052016

RS.TRAUMA CENTRE 26/05/2016 31/12/2017

14 7-3538040133 PUSKESMAS KEDUNGWUNI II

JL TANGKIL KULON KEC KEDUNGWUNI 51173 DINKES KAB PEKALONGAN

PER/005-20/052016

RS.TRAUMA CENTRE

26/05/2016 31/12/2017

15 7-3531741853 PUSKESMAS KESESI I JL RAYA KAIBAHAN KEC KESESI 51162 DINKES KAB PEKALONGAN

PER/005-11/052016

RS.TRAUMA CENTRE

26/05/2016 31/12/2017

16 7-3531810784 PUSKESMAS KESESI II JL RAYA JAGUNG KEC. KESESI 51162DINKES KAB PEKALONGAN

PER/005-12/052016

RS.TRAUMA CENTRE 26/05/2016 31/12/2017

17 7-3502849015 PUSKESMAS LEBAKBARANGJL RAYA LEBAKBARANG KEC LEBAKBARANG 51183


PER/005-3/052016

RS.TRAUMA CENTRE 24/05/2016 31/12/2017

18 7-3502839644 PUSKESMAS PANINGGARANJL RAYA PANINGGARAN KEC PANINGGARAN

51164DINKES KAB PEKALONGAN

PER/005-2/052016

RS.TRAUMA CENTRE

24/05/2016 31/12/2017

19 7-3502860266 PUSKESMAS PETUNGKRIONO

JL RAYA PETUNGKRIONO KEC PETUNGKRIONO


PER/005-4-052016

RS.TRAUMA CENTRE

24/05/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


297 / 44607-11-201606:23:31



IKS


20 7-3536042918 PUSKESMAS SIWALAN JL RAYA PAIT KEC SRAGI 51155 DINKES KAB PEKALONGAN

PER/005-15/052016

RS.TRAUMA CENTRE 26/05/2016 31/12/2017

21 7-3534640466 PUSKESMAS SRAGI I JL RAYA SRAGI KEC SRAGI 51155 DINKES KAB PEKALONGAN

PER/005-13/052016

RS.TRAUMA CENTRE 26/05/2016 31/12/2017

22 7-3535900547 PUSKESMAS SRAGI II JL RAYA KALIJAMBE KEC SRAGI 51155 DINKES KAB PEKALONGAN

PER/005-14/052016

RS.TRAUMA CENTRE

26/05/2016 31/12/2017

23 7-3502868917 PUSKESMAS TALUN JL RAYA KALI REJO KEC TALUN 51192 DINKES KAB PEKALONGAN

PER/005-5/052016

RS.TRAUMA CENTRE

24/05/2016 31/12/2017

24 7-3538737476 PUSKESMAS TIRTO I JL RAYA PACAR TIRTO 51151 DINKES KAB PEKALONGAN

PER/005-23/052016

RS.TRAUMA CENTRE 26/05/2016 31/12/2017

25 7-3539061917 PUSKESMAS TIRTO II JL TEGALDOWO KEC TIRTO 51151DINKES KAB PEKALONGAN

PER/005-24/052016

RS.TRAUMA CENTRE 26/05/2016 31/12/2017

26 7-3539163668 PUSKESMAS WIRADESA JL RAYA A YANI KEC WIRADESA 51127 DINKES KAB PEKALONGAN

PER/005-25/052016

RS.TRAUMA CENTRE

26/05/2016 31/12/2017

27 7-3539982813 PUSKESMAS WONOKERTO I DESA WONOKERTO KEC WIRADESA 51127 DINKES KAB PEKALONGAN

PER/005-26/052016

RS.TRAUMA CENTRE

26/05/2016 31/12/2017

28 7-3540204784 PUSKESMAS WONOKERTO II DESA WERDI KEC WONOKERTO 51153DINKES KAB PEKALONGAN

PER/005-27/052016

RS.TRAUMA CENTRE 26/05/2016 31/12/2017

29 7-3537524911 PUSKESMAS WONOPRINGGOJL RAYA PEGADEN NO 112 KEC WONOPRINGGO 51181


PER/005-18/052016

RS.TRAUMA CENTRE 26/05/2016 31/12/2017

30 1500000001805 RS BUDI RAHAYU JL BARITO NO 5 51113 423491PER / 08 / 052015

RS.TRAUMA CENTRE

01/07/2015 30/06/2016

31 1500000001805 RS BUDI RAHAYU JL BARITO NO 5 51113 423491 PER / 12 / 052016

RS.TRAUMA CENTRE

01/07/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


298 / 44607-11-201606:23:31



IKS


32 1500000001799 RS MUHAMMADIYAH RODLIYAH ACHID MOGA JL RAYA MOGA PULOSARI KM 2 MOGA 52315 86267099 PD MUHAMMADIYAH

PEMALANGPER / 014 / 062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

33 1500000001799 RS MUHAMMADIYAH RODLIYAH ACHID MOGA JL RAYA MOGA PULOSARI KM 2 MOGA 52315 86267099 PD MUHAMMADIYAH

PEMALANGPER / 015 / 052016

RS.TRAUMA CENTRE 01/07/2016 31/12/2017

34 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

35 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

36 1500000001804 RS SITI KHODIJAH JL BANDUNG NO 39 SUGIH WARAS 51111 422845 YAYASAN AL IRSYAD ALISLAMIYYAH

PER / 013 / 052016

RS.TRAUMA CENTRE 01/07/2016 31/12/2017

37 1500000001804 RS SITI KHODIJAH JL BANDUNG NO 39 SUGIH WARAS 51111 422845YAYASAN AL IRSYAD ALISLAMIYYAH

PER / 017 / 062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

38 1500000000214 RSI PKU MUHAMMADIYAH PEKAJANGAN

JL RAYA AMBOKEMBANG NO 42-43 KEDUNGWUNI

51173 785133 YAYASAN MUHAMMADIYAH

PER / 002 / 022016

RS.TRAUMA CENTRE

02/03/2016 31/12/2017

39 1500000001239 RSU ARO JL DR SOETOMO GAMER 4416443 DR BROTO RAHARDJO PER / 006 / 052016

RS.TRAUMA CENTRE

01/06/2016 31/12/2017

40 1500000001239 RSU ARO JL DR SOETOMO GAMER 4416443 DR BROTO RAHARDJO PER/12/062015RS.TRAUMA CENTRE 01/06/2015 31/05/2016

41 1500000001240 RSU KAROMAH HOLISTIC JL GADJAHMADA BARAT NO.124 420218 DR. ASTRID WIDYASTUTIPER / 007 / 052016

RS.TRAUMA CENTRE 01/06/2016 31/12/2017

42 1500000001240 RSU KAROMAH HOLISTIC JL GADJAHMADA BARAT NO.124 420218 DR. ASTRID WIDYASTUTI PER/10/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

43 1400000000008 RSU SANTA MARIA PEMALANG

JL PEMUDA NO 24 321251 DR WIDODO YULIANTO,MKES M


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


299 / 44607-11-201606:23:31



IKS


44 1400000000008 RSU SANTA MARIA PEMALANG JL PEMUDA NO 24 321251 DR WIDODO

YULIANTO,MKES MPER / 008 / 052016

RS.TRAUMA CENTRE 01/06/2016 31/12/2017

45 7-3533691685 RSU SIAGA MEDIKA PEMALANG

JL PERINTIS KEMERDEKAAN NO 1 KELURAHAN BEJI KEC PEMALANG 52311 028432477

7YAYASAN SIAGA SEJAHTERA PER/004/052016 RS.TRAUMA

CENTRE 26/05/2016 31/12/2017

46 1500000001214 RSUD BENDAN JL SRIWIJAYA NO 2 437232 DR BAMBANG PRASETIJO

PER / 009 /062016

RS.TRAUMA CENTRE

01/06/2016 31/12/2017

47 1500000001214 RSUD BENDAN JL SRIWIJAYA NO 2 437232 DR BAMBANG PRASETIJO


01/06/2015 31/05/2016

48 1500000001806 RUMAH SAKIT H.A. DJUNAID JL PELITA II BUARAN PEKALONGAN 51117 PER / 014 / 052016

RS.TRAUMA CENTRE 01/07/2016 31/12/2017

49 1500000001806 RUMAH SAKIT H.A. DJUNAID JL PELITA II BUARAN PEKALONGAN 51117PER / 016 / 062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

KANTOR CABANG : L05- KANTOR CABANG KUDUS


IKS


1 1500000001992KLINIK PRATAMA AMAL SEHAT JL DESA SADANG RT 04/04 JEULO 59316 437376 DR MUSTIKO WIBOWO PER/29/X/2015

RS.TRAUMA CENTRE 01/10/2015 30/09/2016

2 1500000001992KLINIK PRATAMA AMAL SEHAT

JL DESA SADANG RT 04/04 JEULO 59316 437376 DR MUSTIKO WIBOWO PER/24/102016RS.TRAUMA CENTRE

04/10/2016 31/12/2017

3 1500000000942 KLINIK PRATAMA ANUGERAH HEXA

JL JEPARA KM 3 TERSONO GARUNG LOR KALIWUNGU

DR ANWAR RIYANTO PER/11/042016 RS.TRAUMA CENTRE

14/04/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


300 / 44607-11-201606:23:31



IKS


4 1500000000942 KLINIK PRATAMA ANUGERAH HEXA

JL JEPARA KM 3 TERSONO GARUNG LOR KALIWUNGU DR ANWAR RIYANTO PER/015/052015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

5 1500000001995 KLINIK PRATAMA BINA MEDICA JL. KUDUS PURWODADI KM 8 UNDAAN LOR 59316 42427610 FAQIH, SKM PER/033/X/2015 RS.TRAUMA

CENTRE 01/10/2015 30/09/2016

6 1500000001995 KLINIK PRATAMA BINA MEDICA

JL. KUDUS PURWODADI KM 8 UNDAAN LOR 59316 42427610 FAQIH, SKM PER/25/102016 RS.TRAUMA CENTRE

04/10/2016 31/12/2017

7 7-3622074573 KLINIK PRATAMA BUDI HUSADA

JL SURYO KUSUMO RT 02/01 JEPANG MEJOBO KUDUS

59312 MOCH BUDI SETIAWAN PER/21/062016 RS.TRAUMA CENTRE

01/07/2016 31/12/2017

8 1500000001666 KLINIK PRATAMA CAHAYA HUSADA JL GETAS PEJATEN RT 01 RW03 JATI 325784324 DR BOBY HADI

SARHASTANTO PER/018/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

9 1500000001666KLINIK PRATAMA CAHAYA HUSADA JL GETAS PEJATEN RT 01 RW03 JATI 325784324

DR BOBY HADI SARHASTANTO PER/18/062016

RS.TRAUMA CENTRE 10/06/2016 31/12/2017

10 7-3843107573 KLINIK PRATAMA FATMA MEDIKA

JL. RAYA NALUMSARI KM 2 DESA GEMIRING KIDUL RT 002 RW 005 KEC. NALUMSARI

59466 MUDRIKATUN,SKM,S,SIT,MMKES,MH


13/07/2016 31/12/2017

11 1500000000943 KLINIK PRATAMA MASYITHOH

JL KYAI TELINGSING 51 SUNGGINGAN 440543 BP MASYITHOH PER/12/052016 RS.TRAUMA CENTRE

10/06/2016 31/12/2017

12 1500000000943KLINIK PRATAMA MASYITHOH JL KYAI TELINGSING 51 SUNGGINGAN 440543 BP MASYITHOH PER/019/052015

RS.TRAUMA CENTRE 04/05/2015 30/04/2016

13 1500000001989 KLINIK PRATAMA SEHATI JL. PATIMURA RT 05/01 LORAM KULON 59318 4246276 DR HARIYANTO PER/26/102016RS.TRAUMA CENTRE 04/10/2016 31/12/2017

14 1500000001989 KLINIK PRATAMA SEHATI JL. PATIMURA RT 05/01 LORAM KULON 59318 4246276 DR HARIYANTO PER/032/X/2015RS.TRAUMA CENTRE

01/10/2015 30/09/2016

15 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 : 01/01/2015 s/d 31/10/2016


301 / 44607-11-201606:23:31



IKS


16 7-1073301393 KLINIK PRATAMA SEJAHTERA JL RA KARTINI NO 15 PATI 59111 DR JOKO MARDIYANTO PER/27/102016 RS.TRAUMA

CENTRE 04/10/2016 31/12/2017

17 1500000001991 KLINIK PRATAMA SURYA MEDIKA

JL.SURYO KUSOMO NO,337 MEJOBO RT 03/02 MEJOBO 59318 7437747 DR CHUSNUL KHOTIMAH PER/33/X/2015 RS.TRAUMA

CENTRE 01/10/2015 30/09/2016

18 1500000001991 KLINIK PRATAMA SURYA MEDIKA

JL.SURYO KUSOMO NO,337 MEJOBO RT 03/02 MEJOBO

59318 7437747 DR CHUSNUL KHOTIMAH PER/28/102016 RS.TRAUMA CENTRE

04/10/2016 31/12/2017

19 1500000000641 POLIKLINIK YASMIN MEDIKA

JL SOEKARNO HATTA KM 4.8 RT 7/8 TAHUNAN

727047406 DINY NOOR KHAYATI PER/13/04215 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

20 1500000000641 POLIKLINIK YASMIN MEDIKA

JL SOEKARNO HATTA KM 4.8 RT 7/8 TAHUNAN 727047406 DINY NOOR KHAYATI PER/10/042016 RS.TRAUMA

CENTRE 14/04/2016 31/12/2017

21 1500000000947 RS GRAHA HUSADA JEPARA JL MH THAMRIN NO 14 PANGGANG 597807 DR HENY DYAH LISIANA PER/13/052016RS.TRAUMA CENTRE 10/06/2016 31/12/2017

22 1500000000947 RS GRAHA HUSADA JEPARA JL MH THAMRIN NO 14 PANGGANG 597807 DR HENY DYAH LISIANA PER/017/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

23 1500000001985 RS KARTIKA HUSADA KUDUS

JL JEND SUDIRMAN NO.64 59317 432532 RS KARTIKA HUSADA PER/0026/102015

RS.TRAUMA CENTRE

01/10/2015 30/09/2017

24 1500000000334 RS MARDIRAHAYU KUDUS JL AKBP AGIL KUSUMADYA 110 434707 RS MARDIRAHAYU PER/004/012015RS.TRAUMA CENTRE 01/01/2015 31/12/2015

25 1500000001178 RS MITRA BANGSA JL KOLONEL SUGIONO NO 75 382555 YAYASAN WALI SONGO PER/22/072016RS.TRAUMA CENTRE 12/08/2016 31/12/2017

26 1500000001178 RS MITRA BANGSA JL KOLONEL SUGIONO NO 75 382555 YAYASAN WALI SONGO PER/28/052015RS.TRAUMA CENTRE

04/05/2015 30/06/2016

27 1500000001386 RS NURUSSYIFA KUDUS JL RAYA KUDUS PATI KM 10 4246440 RS NURUSSYIFA PER/020/052015 RS.TRAUMA CENTRE

04/05/2015 30/04/2017


Periode : 01/01/2015 s/d 31/10/2016


302 / 44607-11-201606:23:31



IKS


28 1500000000661 RS PERMATA JL REKSODIPURO NO 57 531624 PER/014/042015 RS.TRAUMA CENTRE 01/04/2015 31/03/2016

29 1500000000661 RS PERMATA JL REKSODIPURO NO 57 531624 PER/08/042016 RS.TRAUMA CENTRE 14/04/2016 31/12/2017

30 1500000001387 RS PKU MUHAMADIYAH MAYONG

JL RAYA NO.12 MAYONG LOR JEPARA 4256500 RS PKU MUHAMMADIYAH


10/06/2016 31/12/2017

31 1500000001387 RS PKU MUHAMADIYAH MAYONG

JL RAYA NO.12 MAYONG LOR JEPARA 4256500 RS PKU MUHAMMADIYAH


04/05/2015 03/05/2016

32 1500000001678 RS PKU MUHAMMADIYAH BLORA JL RAYA CEPU KM 3 BLORA 58217 532257 RS PKU


33 1500000001678RS PKU MUHAMMADIYAH BLORA JL RAYA CEPU KM 3 BLORA 58217 532257

RS PKU MUHAMMADIYAH PER/19/062016

RS.TRAUMA CENTRE 10/06/2016 31/12/2017

34 1500000001389 RS SEBENING KASIH PATI JL. RAYA TAYU PATI KM 3 PAKIS 4150645 DR INDAH RESTIYANTI PER/018/052015 RS.TRAUMA CENTRE

04/05/2015 03/05/2016

35 1500000001389 RS SEBENING KASIH PATI JL. RAYA TAYU PATI KM 3 PAKIS 4150645 DR INDAH RESTIYANTI PER/16/052016 RS.TRAUMA CENTRE

10/06/2016 31/12/2017

36 1400000000314RS UMUM DAERAH KABUPATEN KUDUS JL. LUKMONOHADI NO 19 KUDUS 444001 RSUD KAB KUDUS PER/008/012015

RS.TRAUMA CENTRE 02/01/2015 31/12/2016

37 1500000000335 RSI ARAFAH REMBANGJL RAYA REMBANG LASEM KM5 TRITUNGGAL 531666 RSI ARAFAH REMBANG PER/10/032015

RS.TRAUMA CENTRE 01/03/2015 31/03/2016

38 1500000000335 RSI ARAFAH REMBANGJL RAYA REMBANG LASEM KM5 TRITUNGGAL

531666 RSI ARAFAH REMBANG PER/07/042016RS.TRAUMA CENTRE

14/04/2016 31/12/2017

39 1500000000642 RSI ISLAM PATI JL RAYA PATI TAYU KM 18 DS WATUROYO MARGOYOSO

YKM NU PER/06/042016 RS.TRAUMA CENTRE

14/04/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


303 / 44607-11-201606:23:31



IKS


40 1500000000642 RSI ISLAM PATI JL RAYA PATI TAYU KM 18 DS WATUROYO MARGOYOSO YKM NU PER/011/042015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

41 1500000000138 RSI SULTAN HADLIRIN JEPARA

JL RAYA JEPARA BANGSRI KM 3 DS KUWASEN 591507 RSI SULTAN HADLIRIN

JEPARA PER/003/01/2015 RS.TRAUMA CENTRE 20/01/2015 20/01/2016

42 1500000000138 RSI SULTAN HADLIRIN JEPARA

JL RAYA JEPARA BANGSRI KM 3 DS KUWASEN

591507 RSI SULTAN HADLIRIN JEPARA


02/02/2016 31/12/2017

43 05896 RSK MARDI RAHAYU JL AKBP R AGIL KUSUMADYA NO 110 KUDUS

434707YAYASAN KRISTEN KESEJAHTERAAN MARDIRAHAYU


20/01/2016 31/12/2016

44 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

45 1500000000164RSU DR R SOETIJONO BLORA JL DR SUTOMO NO 42 531118 RSU DR R SOETIJONO PER/001/012015

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

46 1500000001667 RSU FASTABIQ SEHAT PKU MUHAMMADIYAH

JL. RAYA TAYU KM 3 TAMBAH HARJO 4199008 DR ARDILLA S PER/021/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

47 1500000001667 RSU FASTABIQ SEHAT PKU MUHAMMADIYAH

JL. RAYA TAYU KM 3 TAMBAH HARJO 4199008 DR ARDILLA S PER/20/062016 RS.TRAUMA CENTRE

10/06/2016 31/12/2017

48 1400000000465RSUD DOKTER R SOETRASNO REMBANG JL. PAHLAWAN NO.16 691444

RSUD DOKTER R SOETRASNO REMBANG PER/24/092016

RS.TRAUMA CENTRE 09/09/2016 31/12/2017

49 1400000000465RSUD DOKTER R SOETRASNO REMBANG JL. PAHLAWAN NO.16 691444

RSUD DOKTER R SOETRASNO REMBANG PER/027/092015

RS.TRAUMA CENTRE 01/09/2015 31/08/2016

50 7-1061786476RSUD DR LOEKMONO HADI KUDUS

JL DR LOEKMONO HADI NO 19 KUDUS 593190291444001

PEMERINTAH DAERAH440/327/23.01.01/2015

RS.TRAUMA CENTRE

07/01/2016 31/12/2016

51 1500000001986 RSUD DR R SOEPRAPTO CEPU

JLN RONGGOLAWE NO 50 CEPU 58218 421026 RSUD DR SEPRAPTO CEPU


12/08/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


304 / 44607-11-201606:23:31



IKS


52 1500000001986 RSUD DR R SOEPRAPTO CEPU JLN RONGGOLAWE NO 50 CEPU 58218 421026 RSUD DR SEPRAPTO

CEPUPER/0026/082015

RS.TRAUMA CENTRE 01/08/2015 31/07/2016

53 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

54 1400000000558 RSUD RA KARTINI KABUPATEN JEPARA

JL. WACHID HASYIM NO.100 591175 RSUD JEPARA PER/004/01/2015 RS.TRAUMA CENTRE

12/01/2015 31/01/2016

55 1400000000249 RSUD RAA DR SOEWONDO KAB PATI

JL.DR SUSANTO NO.114 381102 445/31/062014 RS.TRAUMA CENTRE

01/06/2015

56 7-1601479543 RSUD RAA SOEWONDO PATI JL.DR. SUSANTO NO. 114 PATI 59163 DR. SUWORO NURCAHYONO.M.KES PER/009/012016 RS.TRAUMA

CENTRE 26/01/2016 31/12/2016

57 1500000000944 RUMAH SAKIT BUDI AGUNG JL. BAJO NO.7 JUWANA 471321 PRATOMO WIDODO PER/14/052016RS.TRAUMA CENTRE 10/06/2016 31/12/2017

58 1500000000944 RUMAH SAKIT BUDI AGUNG JL. BAJO NO.7 JUWANA 471321 PRATOMO WIDODO PER/016/052015 RS.TRAUMA CENTRE

04/05/2015 30/04/2016

59 1400000000427 RUMAH SAKIT ISLAM SUNAN KUDUS

JL.KUDUS PERMAI NO1 432008 RUMAH SAKIT ISLAM SUNAN KUDUS


01/10/2015 30/09/2017

60 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

61 1500000000137RUMAH SAKIT KUMALASIWI KUDUS

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

RUMAH SAKIT KUMALASIWI KUDUS PER/002/01/2015

RS.TRAUMA CENTRE 21/01/2015 31/12/2015

62 1500000000137RUMAH SAKIT KUMALASIWI KUDUS

JL JEPARA KM 6 DESA MIJEN RT 10 RW 06 KALIWUNGU

4245551RUMAH SAKIT KUMALASIWI KUDUS


02/02/2016 31/12/2017

63 7-1534312103 RUMAH SAKIT MARDI RAHAYU KUDUS

JL AKBP R AGIL KUSUMADYA KUDUS 59346 DR KHRISNA NUGRAHA W


21/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


305 / 44607-11-201606:23:31



IKS


64 7-1534989054 RUMAH SAKIT UMUM DAERAH KELET JL RAYA KELET KM 33 JEPARA 59431 DR WIDYO KUNTO M.KES

MRSPER/0035/112015

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

65 1500000001668 RUMKITBAN 84.08.05 BLORA JL DR SOETOMO NO.45 22898046 RUMKITBAN.84.08.05 BLORA PER/023/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

66 1500000001668 RUMKITBAN 84.08.05 BLORA JL DR SOETOMO NO.45 22898046 RUMKITBAN.84.08.05 BLORA


10/06/2016 31/12/2017

KANTOR CABANG : L06- KANTOR CABANG MAGELANG


IKS


1 1500000001889 KLINIK PRATAMA BRASTOMOLO

JL TENTARA GENIE PELAJAR PERUM MADURESO ASRI RT 06/04 MADURESO TEMANGGUNG

56229 713656429 SUPARJA PER/18/072016 RS.TRAUMA CENTRE

31/08/2016 30/06/2018

2 1500000001889 KLINIK PRATAMA BRASTOMOLO

JL TENTARA GENIE PELAJAR PERUM MADURESO ASRI RT 06/04 MADURESO TEMANGGUNG

56229 713656429 SUPARJA PER/09/072015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016

3 08355RS PKU MUHAMMADIYAH PURWOREJO JL BRIGJEN KATAMSO NO 144A 325260

YAYASAN RSU PKU MUHAMMADIYAH PER/10/072015

RS.TRAUMA CENTRE 01/07/2015 31/12/2015

4 1500000000112RS PKU MUHAMMADIYAH TEMANGGUNG

JALAN RAYA KEDU KM 2 KALISAT CAMPURSARI BULU TEMANGGUNG 596704

PIMPINAN DAERAH MUHAMMADIYAH TEMANGGUNG


5 7-3936441633RS PKU MUHAMMADIYAH TEMANGGUNG

JL. RAYA KEDU KM 2 KALISAT TEMANGGUNG 56252

0293596704

PIMPINAN DAERAH MUHAMMADIYAH (PDM) KABUPATEN TEMANGGUNG


6 7-5230940160 RS PURWA HUSADA PURWOREJO

JLN GAJAH MADA KM 4 CANDISARI, BANYUURIP, PURWOREJO

54171 0275321998

DR.DR.H. ROCHADI SPB.SPBA(K)


19/10/2016 30/09/2018


Periode : 01/01/2015 s/d 31/10/2016


306 / 44607-11-201606:23:31



IKS


7 1500000001798 RSI KOTA MAGELANG JL. JERUK NO 4A KOTA MAGELANG 56115 368950YAYASAN KESEJAHTERAAN ISLAM KOTA MAGELANG


8 7-3470354703 RSI PURWOREJO JL. MAGELANG KM 2 PURWOREJO 54181 0275325570

PT BHAKTI MULIA ANANDA PER/14/052016 RS.TRAUMA

CENTRE 20/05/2016 30/04/2018

9 7-4204900133 RSJ PROF. DR. SOEROJO MAGELANG

JALAN AHMAD YANI NO 169 MAGELANG 56115 0293363601

KEMENTERIAN KESEHATAN RI


28/07/2016 30/06/2018

10 1500000001234 RSK NGESTI WALUYO JL. PAHLAWAN PARAKAN TEMANGGUNG 596008 YAYASAN YAKKUM PER/05/042015 RS.TRAUMA CENTRE

01/04/2015 31/12/2015

11 1400000000020 RST DR SOEDJONO JL URIP SUMOHARJO NO 48 362813 PER/04/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

12 7-3936733994RST DR SOEDJONO MAGELANG JL. URIP SOEMOHARDJO NO 48 MAGELANG 56113

0293363061

RUMAH SAKIT TK II 04.05.01 DR SOEDJONO MAGELANG


13 1500000001874 RSU PANTI WALUYO PURWOREJO

JL. AHMAD YANI NO 21 PURWOREJO 54112 322096YAYASAN KRISTEN UNTUK KESEHATAN UMUM


30/08/2016 30/06/2018

14 1500000001874 RSU PANTI WALUYO PURWOREJO

JL. AHMAD YANI NO 21 PURWOREJO 54112 322096YAYASAN KRISTEN UNTUK KESEHATAN UMUM


01/07/2015 30/06/2016

15 1400000000467RSU PKU MUHAMMADIYAH PURWOREJO

JL BRIGJEN KATAMSO NO 144A RT 1 RW 5 PANGENREJO PURWOREJO 325260


RS.TRAUMA CENTRE 01/07/2015 31/10/2015


JL BRIGJEN KATAMSO NO 144A RT 1 RW 5 PANGENREJO PURWOREJO 325260


RS.TRAUMA CENTRE 13/04/2016 31/12/2017


JL BRIGJEN KATAMSO NO 144A RT 1 RW 5 PANGENREJO PURWOREJO

325260YAYASAN RSU PKU MUHAMMADIYAH


13/04/2016 31/12/2015

18 7-1712506763 RSUD DR TJITROWARDOJO PURWOREJO

JL. JENDERAL SUDIRMAN NO. 60 PURWOREJO

54114 275321118RSUD DR TJITROWARDOJO PURWOREJO


29/01/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


307 / 44607-11-201606:23:31



IKS


19 1400000000023 RSUD KABUPATEN TEMANGGUNG JL DR SUTOMO NO 67 491119 PER/17/112014 RS.TRAUMA

CENTRE 01/11/2015 31/12/2015

20 1400000000023 RSUD KABUPATEN TEMANGGUNG JL DR SUTOMO NO 67 491119 PER/17/112014 RS.TRAUMA

CENTRE 01/07/2015 31/10/2015

21 1400000000021 RSUD SETJONEGORO WONOSOBO

JL RUMAH SAKIT NO 1 321091 PER/24/122014 RS.TRAUMA CENTRE

01/11/2015 31/12/2015

22 1400000000452 RUMAH SAKIT AISYIYAH MUNTILAN

JL KH.A DAHLAN NO 24 MUNTILAN 587372 PIMPINAN PUSAT MUHAMMADIYAH


01/07/2015 31/10/2015

23 1400000000452 RUMAH SAKIT AISYIYAH MUNTILAN JL KH.A DAHLAN NO 24 MUNTILAN 587372 PIMPINAN PUSAT


24 1400000000452RUMAH SAKIT AISYIYAH MUNTILAN JL KH.A DAHLAN NO 24 MUNTILAN 587372

PIMPINAN PUSAT MUHAMMADIYAH PER/05/012016

RS.TRAUMA CENTRE 29/06/2016 31/12/2017

25 1500000000113 RUMAH SAKIT ISLAM WONOSOBO

JL MAYJEN BAMBANG SUGENG KM 03 MENDOLO BUMIRESO

322961YAYASAN AMAL DAN KESEJAHTERAAN UMAT ISLAM (YAKAUMI)


29/01/2016 31/12/2017

26 1500000000113 RUMAH SAKIT ISLAM WONOSOBO

JL MAYJEN BAMBANG SUGENG KM 03 MENDOLO BUMIRESO

322961YAYASAN AMAL DAN KESEJAHTERAAN UMAT ISLAM (YAKAUMI)


01/07/2015 31/10/2015

27 1500000000113RUMAH SAKIT ISLAM WONOSOBO

JL MAYJEN BAMBANG SUGENG KM 03 MENDOLO BUMIRESO 322961

YAYASAN AMAL DAN KESEJAHTERAAN UMAT ISLAM (YAKAUMI)


28 1500000000113RUMAH SAKIT ISLAM WONOSOBO

JL MAYJEN BAMBANG SUGENG KM 03 MENDOLO BUMIRESO 322961

YAYASAN AMAL DAN KESEJAHTERAAN UMAT ISLAM (YAKAUMI)


29 7-4011004517RUMAH SAKIT PALANG BIRU KUTOARJO

JL MARDITOMO 17 KUTOARJO KAB PURWOREJO

542110275641425

YAYASAN SWANA SANTA PALANG BIRU


01/07/2016 31/05/2018

KANTOR CABANG : L07- KANTOR CABANG TEGAL


Periode : 01/01/2015 s/d 31/10/2016


308 / 44607-11-201606:23:31



IKS


1 1500000001580 KLINIK AZ-ZAHRA JL RAYA LEBAKSIU RT 02/03 LEBAKSIU LOR DR M KARIM AMRULLAH PER/09/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

2 1500000001580 KLINIK AZ-ZAHRA JL RAYA LEBAKSIU RT 02/03 LEBAKSIU LOR DR M KARIM AMRULLAH PER/09/2015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

3 1500000001579 KLINIK KS TUBUN 81 JL KS TUBUN NO 81 RT 01/01 KEL DEBONGTENGAH

0818289836

DR SUHARJO PER/10/2015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

4 1500000001579 KLINIK KS TUBUN 81 JL KS TUBUN NO 81 RT 01/01 KEL DEBONGTENGAH

0818289836

DR SUHARJO PER/10/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

5 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

6 7-2131470963KLINIK NAYAKA HUSADA 06BALAMOA JL PASAR BALAMOA RT 01/01 PANGKAH 52415 DAWAM RAHARJO PER/17/012016

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

7 7-5249342473 KLINIK PRATAMA AL-MADINAH

DS KEMURUNG WETAN RT 01/02 NO 2 KEC TANJUNG KAB BREBES

52211 HJ ELLY SUSYATI S.ST, M.MKES


03/10/2016 31/12/2017

8 7-4574642943 KLINIK PRATAMA HATI MULIA BREBES

JL RAYA BULAKAMBA NO 69 B KARANGSARI

52253 DR UMAR UTOYO PER/20/092016 RS.TRAUMA CENTRE

01/09/2016 31/12/2017

9 1500000001755 KLINIK SEJAHTERA 1DESA TEMBOK LOR RT 10/02 KEC ADIWERNA 52194 7608142 DR NAJMUL IMAN PER/12/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

10 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

11 1500000001756 KLINIK SEJAHTERA 2DESA HARJOSARI KIDUL RT 24/06 KEC ADIWERNA

52194 7608142 DR NAJMUL IMAN PER/13/062015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

12 1500000001756 KLINIK SEJAHTERA 2 DESA 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 : 01/01/2015 s/d 31/10/2016


309 / 44607-11-201606:23:31



IKS


13 7-4613115013 RS ALLAM MEDICA JL PANGERAN DIPONEGORO NO 609 JATISAWIT BUMIAYU 52273 IBU PUJI PER/23/092016 RS.TRAUMA

CENTRE 02/09/2016 31/12/2017

14 7-3947346344 RS AMANAH MAHMUDAH BREBES

JL JENDRAL SUDIRMAN NO 6 SITANGGAL LARANGAN BREBES 52262 HJ. MAHMUDAH PER/19/2016 RS.TRAUMA

CENTRE 27/06/2016 01/06/2017

15 1200000000015 RS BHAKTI ASIH BREBES (TC)

JL P DIPONEGORO PESANTUNAN 125 BREBES

673481 DR KHOSIATUN AZMI PER/05/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

16 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

17 0900000000036 RS DEDY JAYA (TC) JL AHMAD YANI NO 57 672525 DR IRMA YURITA PER/02/012015 RS.TRAUMA CENTRE 02/01/2015 31/12/2015

18 0900000000036 RS DEDY JAYA (TC) JL AHMAD YANI NO 57 672525 DR IRMA YURITA PER/02/2015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

19 7-3515331584 RS DERA AS-SYIFA JL MERDEKA BANJARHARJO BREBES 52265 DR BAMBANG SUJARWOTO


01/06/2016 01/06/2017

20 7-4332292429 RS DERA AS-SYIFA JALAN MERDEKA NO 119 KECAMATAN BANJARHARJO BREBES

52265 DR BAMBANG SUJARWOTO MKES


11/08/2016 01/08/2017

21 1500000000186 RS MITRA SIAGA JL PALA RAYA NO 54 KEC KRAMAT 322550 PER/01/012015RS.TRAUMA CENTRE 01/01/2015 31/12/2015

22 1500000000186 RS MITRA SIAGA JL PALA RAYA NO 54 KEC KRAMAT 322550 PER/01/012015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

23 1000000000009RSI PKU MUHAMMADIYAH KABUPATEN TEGAL(TC)

JALAN RAYA SINGKIL KM 0.5 ADIWERNA 3448180DR H. ACHMAD SHOCHIBUL BIRRI


01/07/2015

24 1000000000009 RSI PKU MUHAMMADIYAH KABUPATEN TEGAL(TC)

JALAN RAYA SINGKIL KM 0.5 ADIWERNA 3448180 DR H. ACHMAD SHOCHIBUL BIRRI


03/03/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


310 / 44607-11-201606:23:31



IKS


25 1500000001754 RSU ADELLA JL PROF MOH YAMIN NO 77 KEL KUDAILE KEC SLAWI 52419 491154 DR H M ABDUL DJALIL

MKES PER/11/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

26 1500000001754 RSU ADELLA JL PROF MOH YAMIN NO 77 KEL KUDAILE KEC SLAWI 52419 491154 DR H M ABDUL DJALIL


27 01626 RSU KARDINAH TEGAL JL KS TUBUN NO. 1 TEGAL PER/14/2015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

28 7-4613378444 RSU MUHAMMADIYAH SITI AMINAH

JL P DIPONEGORO NO 155 BUMIAYU 52273 YAYASAN MUHAMMDIYAH


02/09/2016 31/12/2017

29 0800000000030 RSU SITI ASIYAH JL PASAR WAGE BUMIAYU 41059007 DR H FAISAL AMRI, SH PER/07/0122016 RS.TRAUMA CENTRE 03/03/2016 31/12/2016

30 0800000000030 RSU SITI ASIYAH JL PASAR WAGE BUMIAYU 41059007 DR H FAISAL AMRI, SH PER/07/012015RS.TRAUMA CENTRE 01/01/2015 31/12/2015

31 7-3515134533 RSUD BREBES JL JEND SUDIRMAN NO 181 52211 PEMKAB BREBES PER17/17/042016

RS.TRAUMA CENTRE

24/05/2016 01/05/2017

32 0900000000035 RSUD DR SOESELO SLAWI (TC)

JL DR SUTOMO NO 63 SLAWI 491991 DR WIDODO JOKO MULYONO, M,KES,MMR


01/01/2016 31/12/2016

33 0900000000035RSUD DR SOESELO SLAWI (TC) JL DR SUTOMO NO 63 SLAWI 491991

DR WIDODO JOKO MULYONO, M,KES,MMR PER/04/052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

34 7-1033158771 RSUD KARDINAH TEGAL JL KS TUBUN KOTA TEGAL 52122 PEMKOT TEGAL PER/14/112015RS.TRAUMA CENTRE 17/12/2015 31/12/2016

35 1500000001236 RSUD SURADADIJL RAYA TEGAL-PEMALANG KM.12 SURADADI

3336263PEMERINTAH KABUPATEN TEGAL


01/06/2015 31/12/2015

36 1500000001236 RSUD SURADADI JL RAYA TEGAL-PEMALANG KM.12 SURADADI

3336263 PEMERINTAH KABUPATEN TEGAL


01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


311 / 44607-11-201606:23:31



IKS


37 0900000000029 RSUI HARAPAN ANDA (TC) JL ABABIL NO 42 353387 HABIYAH. MMR PER/03/012015 RS.TRAUMA CENTRE 02/01/2015 31/12/2015

38 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 SEHATJL. RAYA BOYOLALI SELO KM 5 JELOK CEPOGO

081393306461 PT RESTU BUNDA PER/24/112015

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

2 7-1549815415 KLINIK NAYAKA HUSADA 02BOYOLALI

DK. BUTUH MOJOSONGO BOYOLALI 57322 0247605621

YAYASAN DANA PENSIUN KARYAWAN BPJS KETENAGAKERJAAN


25/01/2016 31/12/2016

3 1500000000102 KLINIK PKU MUH JATINOM JL RAYA JATINOM KLATEN KM 1 KLATEN 337334YAYASAN MUHAMMADIYAH CAB JATINOM KLATEN


04/01/2016 31/12/2016

4 1500000000102 KLINIK PKU MUH JATINOM JL RAYA JATINOM KLATEN KM 1 KLATEN 337334YAYASAN MUHAMMADIYAH CAB JATINOM KLATEN


5 1500000000688 KLINIK PKU MUHAMMADIYAH CAWAS

JL CAWAS PEDAN BELAKANG POLSEK CAWAS KLATEN 897661

YAYASAN MUHAMMADIYAH CABANG CAWAS


6 1500000000688KLINIK PKU MUHAMMADIYAH CAWAS

JL CAWAS PEDAN BELAKANG POLSEK CAWAS KLATEN

897661YAYASAN MUHAMMADIYAH CABANG CAWAS


03/05/2016 31/12/2017

7 1500000000444KLINIK PKU MUHAMMADIYAH POLAN HARJO

JL COKRO DELANGGU GUDANG ABANG WANGEN POLANHARJO

557002

PIMPINAN CABANG MUHAMMADIYAH POLANHARJO KABUPATEN KLATEN


13/04/2016 31/03/2017


Periode : 01/01/2015 s/d 31/10/2016


312 / 44607-11-201606:23:31



IKS


8 1500000000444KLINIK PKU MUHAMMADIYAH POLAN HARJO

JL COKRO DELANGGU GUDANG ABANG WANGEN POLANHARJO 557002

PIMPINAN CABANG MUHAMMADIYAH POLANHARJO KABUPATEN KLATEN


9 7-4354798673 KLINIK PRATAMA NURANI HUSADA

BANARAN RT/RW 002/001 PUGERAN KARANGDOWO 57464 081226469

90

DR SRI HARTATI HANDAYANI, SP.P., M.KES


10 1500000001520KLINIK PRATAMA PMI KABUPATEN BOYOLALI

JL RANDU ASRI KP KOPLAK SISWODIPURAN 3283734 PMI KAB BOYOLALI PER/22/072016

RS.TRAUMA CENTRE 22/07/2016 31/12/2017

11 1500000001520 KLINIK PRATAMA PMI KABUPATEN BOYOLALI

JL RANDU ASRI KP KOPLAK SISWODIPURAN

3283734 PMI KAB BOYOLALI PER/15/062015 RS.TRAUMA CENTRE

22/06/2015 21/05/2016

12 1500000000083 KLINIK PRATAMA RAWAT INAP MILA HUSADA

JL . RAYA PENGGING KM 02 BANYUDONO BOYOLALI 327453 DR. H DIDIK SUPRAPTO PER/05/012016 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

13 1500000000083KLINIK PRATAMA RAWAT INAP MILA HUSADA

JL . RAYA PENGGING KM 02 BANYUDONO BOYOLALI 327453 DR. H DIDIK SUPRAPTO

PER/01/JKK/012015

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

14 1500000001869 KLINIK PRATAMA RAWAT INAP REJOSARI HUSADA

JL DELANGGU POLANHARJO NO 41 REJOSARI SABRANG

57411 552215 PT PRABAWATAMA INDONESIA


23/07/2015 22/06/2016

15 1500000001869 KLINIK PRATAMA RAWAT INAP REJOSARI HUSADA

JL DELANGGU POLANHARJO NO 41 REJOSARI SABRANG

57411 552215 PT PRABAWATAMA INDONESIA


23/07/2016 31/12/2017

16 7-4354901524KLINIK PRATAMA RAWAT JALAN BSMI KLATEN

JL PRAMBANAN-MANISRENGGO, PEMUKTI BARU, TLOGO, PRAMBANAN, KLATEN 57454

0274850241

RAHMAT HERIONO,SS.,MA PER/25/082016

RS.TRAUMA CENTRE 12/08/2016 31/12/2017

17 1500000000293 KLINIK UPK PMI KLATEN JL. VETERAN NO 80 KLATEN UTARA 8850400 DR TRI ARI SUSANTO PER/03/032015 RS.TRAUMA CENTRE 02/03/2015 29/02/2016

18 1500000000293 KLINIK UPK PMI KLATEN JL. VETERAN NO 80 KLATEN UTARA 8850400 DR TRI ARI SUSANTO PER/009/032016RS.TRAUMA CENTRE

03/03/2016 31/12/2017

19 1400000000147 RS HIDAYAH BOYOLALI KRAGILAN MOJOSONGO BOYOLALI 324614 YAYASAN DUA SEPTEMBER BOYOLALI


01/06/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


313 / 44607-11-201606:23:31



IKS


20 1400000000147 RS HIDAYAH BOYOLALI KRAGILAN MOJOSONGO BOYOLALI 324614 YAYASAN DUA SEPTEMBER BOYOLALI PER/12/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

21 1500000001975 RS ISLAM BANYU BENING JL RAYA WADUK CENGKLIK NGARGOREJO NGEMPLAK BYL 7910812 YAYASAN RS ISLAM

BANYUBENING PER/22/102015 RS.TRAUMA CENTRE 12/10/2015 11/09/2016

22 1500000001975 RS ISLAM BANYU BENING JL RAYA WADUK CENGKLIK NGARGOREJO NGEMPLAK BYL

7910812 YAYASAN RS ISLAM BANYUBENING


20/09/2016 31/12/2017

23 1500000000445 RS KARANGGEDE SISMA MEDIKA

JL RAYA KARENGGEDE SOLO KM 1 KEBONAN KARANGGEDE BOYOLALI

610600PT SISMADI MEDCORPINDO BOYOLALI


13/04/2016 31/03/2017

24 1500000000445 RS KARANGGEDE SISMA MEDIKA

JL RAYA KARENGGEDE SOLO KM 1 KEBONAN KARANGGEDE BOYOLALI 610600

PT SISMADI MEDCORPINDO BOYOLALI


25 0800000000001 RSI KLATEN JL YOGYA-SOLO KETANDAN KLATEN PER/18/092015RS.TRAUMA CENTRE 01/09/2015 31/12/2015

26 0800000000001 RSI KLATEN JL YOGYA-SOLO KETANDAN KLATEN PER/01/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

27 7-4275123231 RSJD DR RM SOEDJARWADI PROVINSI JAWA TENGAH

JL KI PANDANARAN KM 2 KLATEN 57461 0272321435

DR TRI KUNCORO, MMR PER/23/072016 RS.TRAUMA CENTRE

12/08/2016 31/12/2017

28 1500000000292RSU ASY SYIFA SAMBI BOYOLALI

JL RAYA BANGAK SIMO KM 7 SAMBI BOYOLALI 3294459

YAYASAN KARTIKA HUSADA SAMBI PER/04/032015

RS.TRAUMA CENTRE 02/03/2015 29/02/2016

29 1500000000292RSU ASY SYIFA SAMBI BOYOLALI

JL RAYA BANGAK SIMO KM 7 SAMBI BOYOLALI 3294459

YAYASAN KARTIKA HUSADA SAMBI PER/010/03/2016

RS.TRAUMA CENTRE 03/03/2016 31/12/2017

30 7-1550676406RSU CAKRA HUSADA KLATEN

JL. MERBABU NO 7 57412 PT CAKRA HUSADA PER/08/012016RS.TRAUMA CENTRE

25/01/2016 31/12/2016

31 0800000000004 RSU PANDAN ARANG BOYOLALI

JL KANTIL 14 BOYOLALI PER/19/092015 RS.TRAUMA CENTRE

01/09/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


314 / 44607-11-201606:23:31



IKS


32 0800000000004 RSU PANDAN ARANG BOYOLALI JL KANTIL 14 BOYOLALI PER/02/012016 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

33 1100000000010 RSU PKU AISYIYAH BOYOLALI

JL. PASAR SAPI BARU SINGKIL-KARANGGENENG BOYOLALI 322898 PER/13/04/2016 RS.TRAUMA

CENTRE 03/05/2016 31/12/2017

34 1100000000010 RSU PKU AISYIYAH BOYOLALI

JL. PASAR SAPI BARU SINGKIL-KARANGGENENG BOYOLALI


01/05/2015 30/04/2016

35 0800000000002 RSU SOERADJI TIRTONEGORO

JL SURADJI TIRTONEGORO PER/218/092015 RS.TRAUMA CENTRE

01/09/2015 31/12/2015

36 0800000000002 RSU SOERADJI TIRTONEGORO JL SURADJI TIRTONEGORO PER/04/012016 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

37 0800000000005 RSUD BANYUDONO JL RAYA SOLO-SEMARANG085647136655 PEMDA PER/03/012016

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

38 0800000000005 RSUD BANYUDONO JL RAYA SOLO-SEMARANG 085647136655

PEMDA PER/20/092015 RS.TRAUMA CENTRE

01/09/2015 31/12/2015

39 1400000000253RUMAH SAKIT PKU MUHAMMADIYAH DELANGGU

JL RAYA DELANGGU UTARA NO 19 DELANGGU KLATEN

551051YAYASAN MUHAMMADIYAH CABANG DELANGGU


22/07/2016 31/12/2017

40 1400000000253RUMAH SAKIT PKU MUHAMMADIYAH DELANGGU

JL RAYA DELANGGU UTARA NO 19 DELANGGU KLATEN 551051

YAYASAN MUHAMMADIYAH CABANG DELANGGU


KANTOR CABANG : L09- KANTOR CABANG PURWOKERTO


Periode : 01/01/2015 s/d 31/10/2016


315 / 44607-11-201606:23:31



IKS


1 1500000000603 BKMM KABUPATEN BANYUMAS JL JEND SUDIRMAN PURWOKERTO 53111 635602 DINAS KESEHATAN

KABUPATEN BANYUMASPER/009/012016-2

RS.TRAUMA CENTRE 26/05/2016 31/12/2017

2 1500000000603 BKMM KABUPATEN BANYUMAS JL JEND SUDIRMAN PURWOKERTO 53111 635602 DINAS KESEHATAN

KABUPATEN BANYUMAS PER/18/042015 RS.TRAUMA CENTRE 01/04/2015 31/12/2015

3 1400000000575 BP PMI PURBALINGGA JL LETKOL ISDIMAN NO 116 PURBALINGGA 891359 PER/36/092015 RS.TRAUMA CENTRE

01/09/2015 31/12/2015

4 1400000000575 BP PMI PURBALINGGA JL LETKOL ISDIMAN NO 116 PURBALINGGA 891359 PER/009.8/012016

RS.TRAUMA CENTRE

28/09/2016 31/12/2017

5 1500000000627 KLINIK ANASTASIA GEMURUH RT 5/1 BAWANG BAMBANG WP PER/009.10/012016

RS.TRAUMA CENTRE 04/08/2016 31/12/2017

6 1500000000627 KLINIK ANASTASIA GEMURUH RT 5/1 BAWANG BAMBANG WP PER/20/052015RS.TRAUMA CENTRE 01/05/2015 31/12/2015

7 1500000000418 KLINIK KURNIA JL RAYA SAMPANG KM 4 BUNTU KALIWEDIKEBASEN

5295250 YAYASAN IMAM CHALIFAH


01/01/2015 31/12/2015

8 1400000000571KLINIK PKU MUHAMMADIYAH PURBALINGGA

JL KOL SUGIRI GANDASULI BOBOTSARI 758808 PDM PURBALINGGA PER/009.3/012016

RS.TRAUMA CENTRE

30/05/2016 31/12/2017

9 1400000000571KLINIK PKU MUHAMMADIYAH PURBALINGGA

JL KOL SUGIRI GANDASULI BOBOTSARI 758808 PDM PURBALINGGA PER/05/012015RS.TRAUMA CENTRE 01/01/2015 31/12/2015

10 1500000000629 KLINIK PMI BANYUMAS JL ADYAKSA NO 8 PURWOKERTO 636842 PMI BANYUMAS PER/23/052015RS.TRAUMA CENTRE 01/05/2015 31/05/2016

11 1500000000629 KLINIK PMI BANYUMAS JL ADYAKSA NO 8 PURWOKERTO 636842 PMI BANYUMASPER/009.11/012016

RS.TRAUMA CENTRE

10/10/2016 31/12/2017

12 1500000000117 KLINIK SEHAT AMANAH JL INPRES NO 20 TAMBAKSARI SETYOWATI INDRAYANI PER/009.6/012016

RS.TRAUMA CENTRE

10/06/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


316 / 44607-11-201606:23:31



IKS


13 1500000000117 KLINIK SEHAT AMANAH JL INPRES NO 20 TAMBAKSARI SETYOWATI INDRAYANI PER/10/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

14 1500000000626 KLINIK UMP JL RAYA DUKUHWALUH KEMBARAN 53182 636751-109 KLINIK PRATAMA UMP PER/009.5/012016

RS.TRAUMA CENTRE 26/05/2016 31/12/2017

15 1500000000626 KLINIK UMP JL RAYA DUKUHWALUH KEMBARAN 53182 636751-109 KLINIK PRATAMA UMP PER/12/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

16 1500000000351 KLINIK UTAMA AMANDA PURWOKERTO

JL MARTADIREJA II NO 32 PURWOKERTO 642484 SUHARNO PER/15/032015 RS.TRAUMA CENTRE

01/03/2015 31/12/2015

17 1500000000351 KLINIK UTAMA AMANDA PURWOKERTO JL MARTADIREJA II NO 32 PURWOKERTO 642484 SUHARNO PER/009.7/01201

6RS.TRAUMA CENTRE 03/06/2016 31/12/2017

18 1500000001090 KLINIK YOS SUDARSO JL SIDODADI 2/7 SOKARAJA BANYUMAS 6440963YYS SOSIAL BINA SEJAHTERA

PER/009.4/012016

RS.TRAUMA CENTRE 03/10/2016 31/12/2017

19 1500000001090 KLINIK YOS SUDARSO JL SIDODADI 2/7 SOKARAJA BANYUMAS 6440963 YYS SOSIAL BINA SEJAHTERA


01/06/2015 31/05/2016

20 1500000001700 PUSKESMAS BOBOTSARI (PURBALINGGA)

JL. RS. YOSOMIHARJO 16 KEC. BOBOTSARI PURBALINGGA

53353 758678 DR. NONOT MULYONO PER/29/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

21 1500000001679PUSKESMAS BOJONG (PURBALINGGA) JL. RAYA BOJONG NO. 130 PURBALINGGA 53362 895680 DR. NONOT MULYONO PER/29/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

22 1500000001682PUSKESMAS BOJONGSARI (PURBALINGGA)

JL. RAYA BOJONGSARI 28 KEC. BOJONGSARI PURBALINGGA 53362 6596981 DR. NONOT MULYNO PER/29/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

23 1500000001696PUSKESMAS BUKATEJA (PURBALINGGA)

JL.ARGANDARU NO.1 KEC BUKATEJA PURBALINGGA RT 4 RW 1

53382 476050 DR. NONOT MULYONO PER/29/062015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

24 1500000001695 PUSKESMAS KALIGONDANG(PURBALINGGA)

JL. RAYA SELAKAMBANG KALIGONDANG PURBALINGGA


01/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


317 / 44607-11-201606:23:31



IKS


25 1500000001697 PUSKESMAS KALIKAJAR (PURBALINGGA)

JL. SELAKAMBANG KM. 2,5 NO. 01 KALIAKAJAR PURBALINGGA 53331 893379 DR. NONOT MULYONO PER/29/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

26 1500000001686 PUSKESMAS KALIMANAH (PURBALINGGA)

JL. MAYJEND. SUNGKONO 39 KEC. KALIMANAH PURBALINGGA 53371 892414 DR. NONOT MULYONO PER/29/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

27 1500000001688PUSKESMAS KARANGANYAR (PURBALINGGA)

JL.RY KARANGANYAR /KERTANEGARA NO.3 PURBALINGGA RT 02 RW 1

7632913 DR.NONOT MULYONO PER/29/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

28 1500000001694PUSKESMAS KARANGJAMBU (PURBALINGGA)

JL.RAYA KARANGJAMBU PURBALINGGA RT 09 RW 3


01/06/2015 31/12/2015

29 1500000001703PUSKESMAS KARANGMONCOL (PURBALINGGA)

JL.RY BOBOTSARI-REMBANG KM 11 DS PEPEDAN PURBALINGGA KEC KARANGMONCOL RT 1 RW 8

53355 7621793 DR.NONOT MULYONO PER/29/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

30 1500000001693PUSKESMAS KARANGREJA (PURBALINGGA)

JL JL RAYA KARANGREJA KM 2 PURBALINGGA 7609219 DR.NONOT MULYONO PER/29/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

31 1500000001685PUSKESMAS KARANGTENGAH (PURBALINGGA)

JL.RY KARANG TENGAH KEC KERTANEGARA PURBALINGGA RT 11 RW 3


01/06/2015 31/12/2015

32 1500000001699 PUSKESMAS KEJOBONG (PURBALINGGA)

JL.RAYA KEJOBONG PURBALINGGA KEC KEJOBONG RT 01 RW 01

0822812193

DR.NONOT MULYONO PER/29/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

33 1500000001692PUSKESMAS KEMANGKON (PURBALINGGA)

JL. RAYA PANICAN - KEDUNG BENDA 002/001 KEC. KEMANGKON PURBALINGGA 53381 6591566 DR. NONOT MULYONO PER/29/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

34 1500000001680PUSKESMAS KUTASARI (PURBALINGGA)

JL. RAYA TOBONG - KUTASARI PURBALINGGA 53361 6599183 DR. NONOT MULYONO PER/29/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

35 1500000001698PUSKESMAS KUTAWIS (PURBALINGGA)

JL.RY BUKATEJA-KUTAWIS KM 5 PURBALINGGA RT 1 RW 5

53382 7639694 DR NONOT MULYONO PER/29/062015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

36 1500000001702 PUSKESMAS MREBET (PURBALINGGA)

JL. RAYA MANGUNEGARA KM 08 MANGKUNEGARA KEC. MREBET PURBALINGGA


01/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


318 / 44607-11-201606:23:31



IKS


37 1500000001689 PUSKESMAS PADAMARA (PURBALINGGA)

JL. RAYA PADAMARA KM 6 KEC. PADAMARA PURBALINGGA 53372 6598588 DR. NONOT MULYONO PER/29/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

38 1500000001701 PUSKESMAS PENGADEGAN (PURBALINGGA)

JL.RY PENGADEGAN PURBALINGGA KEC PENGADEGAN RT 11 RW 5 53393 DR.NONOT MULYONO PER/29/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

39 1500000001677 PUSKESMAS PURBALINGGA JL. AW SUMARMO 70 PURBALINGGA 53319 891862 DR. NONOT MULYONO PER/29/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

40 1500000001704 PUSKESMAS REMBANG (PURBALINGGA)

JL.SUDIRMAN KM 5 LOSARI KEC REMBANG 53356 6590539 DR.NONOT MULYONO PER/29/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

41 1500000001681 PUSKESMAS SERAYU LARANGAN (PURBALINGGA)

JL RY SERAYU-LARANGAN KEC MREBET KM 5 PURBALINGGA RT 01 RW 01 53352 7635303 DR NONOT MULYONO PER/29/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

42 1500000000604 RS EMANUEL JL.A.YANI PURWAREJA KLAMPOK 479030 YAKKUM PER/007/012016RS.TRAUMA CENTRE 23/05/2016 31/12/2017

43 1500000000604 RS EMANUEL JL.A.YANI PURWAREJA KLAMPOK 479030 YAKKUM PER/21/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

44 0900000000001 RS ORTHOPAEDI PURWOKERTO

JL SOEPARDJO ROESTAM 99 PWT 6844166 PER/35/092015 RS.TRAUMA CENTRE

01/09/2015 31/12/2015

45 0900000000001RS ORTHOPAEDI PURWOKERTO JL SOEPARDJO ROESTAM 99 PWT 6844166 PER/004/012016

RS.TRAUMA CENTRE 22/06/2016 31/12/2017

46 1500000000628 RS SINAR KASIH JL MARTADIREJA II PURWOKERTO 638370 YAKKUMPER/009.14/012016

RS.TRAUMA CENTRE 31/10/2016 31/12/2017

47 1500000000628 RS SINAR KASIH JL MARTADIREJA II PURWOKERTO 638370 YAKKUM PER/22/052015RS.TRAUMA CENTRE

01/05/2015 31/12/2015

48 1400000000179 RS WIJAYAKUSUMA JL PROF HR BUNYAMIN PURWOKERTO 633062 PER/003/012016-2

RS.TRAUMA CENTRE

02/06/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


319 / 44607-11-201606:23:31



IKS


49 1400000000179 RS WIJAYAKUSUMA JL PROF HR BUNYAMIN PURWOKERTO 633062 PER/06/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

50 1500000000416 RSI BANJARNEGARA JL. RAYA BAWANG KM 8 BANJARNEGARA 082138783429 DR. H SETYOKO M PER/009.2/01201

6RS.TRAUMA CENTRE 10/06/2016 31/12/2017

51 1500000000416 RSI BANJARNEGARA JL. RAYA BAWANG KM 8 BANJARNEGARA 082138783429

DR. H SETYOKO M PER/17/03/2015 RS.TRAUMA CENTRE

01/03/2015 31/12/2015

52 1400000000187 RSI PURWOKERTO JL H MASYHURI NO 39 PURWOKERTO 630019 YARSI PURWOKERTO PER/001/012016 RS.TRAUMA CENTRE

21/01/2016 31/12/2017

53 1400000000187 RSI PURWOKERTO JL H MASYHURI NO 39 PURWOKERTO 630019 YARSI PURWOKERTO PER/02/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

54 1500000000680 RSKB JATIWINANGUN JL JATIWINANGUN NO 54 PURWOKERTO 638169 PT SANATIO PER/19/042015RS.TRAUMA CENTRE 01/04/2015 31/12/2015

55 1500000000680 RSKB JATIWINANGUN JL JATIWINANGUN NO 54 PURWOKERTO 638169 PT SANATIO PER/006/012016 RS.TRAUMA CENTRE

27/04/2016 31/12/2017

56 1400000000282 RSU HARAPAN IBU PURBALINGGA

JL MAYJEND SUNGKONO NO 1 PURBALINGGA

892222 YYS BANI SOBARI PER/01/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

57 1400000000282RSU HARAPAN IBU PURBALINGGA

JL MAYJEND SUNGKONO NO 1 PURBALINGGA 892222 YYS BANI SOBARI PER/008/012016

RS.TRAUMA CENTRE 20/05/2016 31/12/2017

58 7-4990562503RSU SIAGA MEDIKA PURBALINGGA JL LETNAN SUDANI 53372

YAYASAN SIAGA SEJAHTERA PER/012/092016

RS.TRAUMA CENTRE 03/10/2016 31/12/2017

59 1400000000238 RSUD AJIBARANG JL RAYA PANCASAN 6570004PER/002/012016-2

RS.TRAUMA CENTRE

02/06/2016 31/12/2017

60 1400000000238 RSUD AJIBARANG JL RAYA PANCASAN 6570004 PER/03/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


320 / 44607-11-201606:23:31



IKS


61 1500000000467 RSUD BANYUMAS JL RUMAH SAKIT NO 1 BANYUMAS 796031 PER/07/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

62 1400000000399 RSUD DR R GOETENG TAROENADIBRATA JL TENTARA PELAJAR NO 22 896645 PER/009.1/01201

6RS.TRAUMA CENTRE 10/06/2016 31/12/2017

63 1400000000399 RSUD DR R GOETENG TAROENADIBRATA

JL TENTARA PELAJAR NO 22 896645 PER/37/102015 RS.TRAUMA CENTRE

01/10/2015 31/12/2015

64 1500000001279 RSUD HJ ANNA LASMANAH BANJARNEGARA

JL JEND SUDIRMAN 42 BANJARNEGARA 591464 PER/28/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

65 1500000000118 RSUD PROF DR MARGONO SOEKARJO JL DR GUMBREG NO 1 PURWOKERTO 632708 PER/11/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

66 1500000000118RSUD PROF DR MARGONO SOEKARJO JL DR GUMBREG NO 1 PURWOKERTO 632708 PER/005/022016

RS.TRAUMA CENTRE 25/04/2016 31/12/2018

67 1500000000350 RUMAH SAKIT NIRMALA PURBALINGGA

JL. LETNAN YUSUF PURBALINGGA 892844 YAYASAN NIRMALA HUSADA

PER/009.13/012016

RS.TRAUMA CENTRE

13/10/2016 31/12/2017

68 1500000000350 RUMAH SAKIT NIRMALA PURBALINGGA

JL. LETNAN YUSUF PURBALINGGA 892844 YAYASAN NIRMALA HUSADA


02/03/2015 31/12/2015

69 7-3297996775RUMAH SAKIT SIAGA MEDIKA JL PRAMUKA 55 BANYUMAS 53192

YAYASAN SIAGA SEJAHTERA PER/010/052016

RS.TRAUMA CENTRE 13/05/2016 31/12/2017

KANTOR CABANG : L10- KANTOR CABANG UNGARAN


Periode : 01/01/2015 s/d 31/10/2016


321 / 44607-11-201606:23:31



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 1500000000867 GRIYA PELATIHAN APAC (GRIPAC)

JL SOEKARNO HATTA KM.32 DESA HARJOSARI BAWEN 522914 PT APAC INTI CORPORA PER/03/022015 RS.TRAUMA

CENTRE 01/03/2015 31/12/2015

3 1500000001918 KLINIK "COCA-COLA" JL SOEKARNO HATTA KM.30 BAWEN JULIUS ROBIYANTO PER/15/092016 RS.TRAUMA CENTRE

28/09/2016 31/08/2018

4 1500000001918 KLINIK "COCA-COLA" JL SOEKARNO HATTA KM.30 BAWEN JULIUS ROBIYANTO PER/14/082015 RS.TRAUMA CENTRE

24/08/2015 24/08/2016

5 1400000000657 KLINIK APAC INTI CORPORA JL SOEKARNO HATTA KM 32 HARJOSARI BAWEN 522888 H AGUNG WAHONO

SH.MHUM PER/10/062015 RS.TRAUMA CENTRE 01/07/2015 31/12/2015

6 1400000000657 KLINIK APAC INTI CORPORAJL SOEKARNO HATTA KM 32 HARJOSARI BAWEN 522888

H AGUNG WAHONO SH.MHUM PER/06/012016

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

7 1500000001574 KLINIK PRATAMA "MANUNGGAL"

JL ARGO BUSONO NO.1 322480 KOPERASI PT DAMATEX PER/09/062015 RS.TRAUMA CENTRE

22/06/2015 31/12/2015

8 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

9 1500000001917KLINIK PRATAMA KALIMASADHA

JALAN RAYA SALATIGA BOYOLALI KM.9 TENGARAN 9546050 DR CHOIRUL ANAM PER/14/09/2016

RS.TRAUMA CENTRE 28/09/2016 31/08/2018

10 1500000001917KLINIK PRATAMA KALIMASADHA

JALAN RAYA SALATIGA BOYOLALI KM.9 TENGARAN 9546050 DR CHOIRUL ANAM PER/13/082015

RS.TRAUMA CENTRE 20/08/2015 20/08/2016

11 7-631760693 KLINIK TRI KARYAJL TIRTOMOYO NO.96 BANDUNGAN KAB. SEMARANG

506610298712378

LILIS WIJAYANTI PER/15/112015RS.TRAUMA CENTRE

26/11/2015 19/11/2016

12 1400000000656 KLINIK UMUM 24 JAM UMI HABIBAH

JL SYECH BASARUDIN KEL.NGEMPON, BERGAS

526225 SITI MUSRIYATUN PER/11/062015 RS.TRAUMA CENTRE

01/07/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


322 / 44607-11-201606:23:31



IKS


13 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

14 7-2008582105 PUSKESMAS AMBARAWA JL JENDRAL SUDIRMAN NO 76 KEC AMBARAWA KAB SEMARANG 50611 DINAS KESEHATAN

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

15 7-2008950288 PUSKESMAS BANCAK JL JENDRAL SUDIRMAN NO 1 KEC BANCAK KAB SEMARANG

50125 DINAS KESEHATAN KAB SEMARANG


15/02/2016 31/12/2016

16 7-2008215164 PUSKESMAS BANYUBIRU JL WIJAYA KUSUMA 47 KEC BANYUBIRU KAB SEMARANG



15/02/2016 31/12/2016

17 1500000000341 PUSKESMAS BAWEN JL PALAGAN NO. 60 KEC. BAWEN 591539 DINAS KESEHATAN KAB.SEMARANG PER/07/012016 RS.TRAUMA

CENTRE 12/02/2016 31/12/2016

18 1500000000341 PUSKESMAS BAWEN JL PALAGAN NO. 60 KEC. BAWEN 591539DINAS KESEHATAN KAB.SEMARANG PER/04/022015

RS.TRAUMA CENTRE 01/03/2015 31/12/2015

19 1500000000340 PUSKESMAS BERGAS JL SOEKARNO HATTA KEC.BERGAS 6525695 DINAS KESEHATAN KAB SEMARANG


12/02/2016 31/12/2016

20 1500000000340 PUSKESMAS BERGAS JL SOEKARNO HATTA KEC.BERGAS 6525695 DINAS KESEHATAN KAB SEMARANG


01/03/2015 31/12/2015

21 7-2008826037 PUSKESMAS BRINGINJL DIPONOGORO NO 141 BRINGIN KEC BRINGIN KAB SEMARANG 50218

DINAS KESEHATAN KAB SEMARANG PER/07/012016

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

22 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

23 1500000000338 PUSKESMAS DUREN JL KENDALISODO NO.19 KEC.BANDUNGAN 711355DINAS KESEHATAN KAB SEMARANG


12/02/2016 31/12/2016

24 1500000000338 PUSKESMAS DUREN JL KENDALISODO NO.19 KEC.BANDUNGAN 711355 DINAS KESEHATAN KAB SEMARANG


01/03/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


323 / 44607-11-201606:23:31



IKS


25 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

26 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

27 1500000000325 PUSKESMAS GETASAN JL RAYA SALATIGA KOPENG KM 10 KEC.GETASAN

2838099 DINAS KESEHATAN KAB.SEMARANG


01/03/2015 31/12/2015

28 1500000000337 PUSKESMAS JAMBU JL. RAYA SEMARANG MAGELANG KM 4 KEC.JAMBU

593532 DINAS KESEHATAN KAB.SEMARANG


01/03/2015 31/12/2015

29 1500000000337 PUSKESMAS JAMBU JL. RAYA SEMARANG MAGELANG KM 4 KEC.JAMBU 593532 DINAS KESEHATAN

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

30 7-1989943593 PUSKESMAS JETAK DS.JETAK , KEC.GETASAN 507740298314664 DINKES KAB SEMARANG PER/07/012016

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

31 7-2008732846 PUSKESMAS JIMBARAN JL TEGAL PANAS JIMBARAN KEC BAWEN KAB SEMARANG



15/02/2016 31/12/2016

32 7-1990221924 PUSKESMAS KALIWUNGU JL AMPEL SIMO 186, KEC.KALIWUNGU 50221 02763331213

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

12/02/2016 31/12/2016

33 7-2009520872 PUSKESMAS KALONGANJL ARJUNA NO 2 KE UNGARAN TIMUR KAB SEMARANG 50514


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

34 7-2009063660 PUSKESMAS LEREPJL YUDISTIRA RAYA KM 3 KEC UNGARAN TIMUR KAB SEMARANG 50514


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

35 7-2009405851 PUSKESMAS LEYANGANJL PUSKESMAS NO 1 KEC UNGARAN BARATKAB SEMARANG

50512DINAS KESEHATAN KAB SEMARANG


15/02/2016 31/12/2016

36 7-1990444836 PUSKESMAS PABELAN JL PEMUDA NO.98 PABELAN, KEC,PABELAN 50771 0298321124

DINAS KESEHATAN KAB.SEMARANG


12/02/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


324 / 44607-11-201606:23:31



IKS


37 1500000000339 PUSKESMAS PRINGAPUS JL.HONGOWICONO NO.5 KEC. PRINGAPUS 25721150 DNIAS KESEHATAN KAB.SEMARANG PER/04/022015 RS.TRAUMA

CENTRE 01/03/2015 31/12/2015

38 1500000000339 PUSKESMAS PRINGAPUS JL.HONGOWICONO NO.5 KEC. PRINGAPUS 25721150 DNIAS KESEHATAN KAB.SEMARANG PER/07/012016 RS.TRAUMA

CENTRE 12/02/2016 31/12/2016

39 7-1990583417 PUSKESMAS SEMOWO DS SEMOWO , KEC. PABELAN 50771 02987100985



12/02/2016 31/12/2016

40 1500000000336 PUSKESMAS SUMOWONO JL.PAHLAWAN NO.15 KEC SUMOWONO 40575050 DINAS KESEHATAN KAB.SEMARANG


12/02/2016 31/12/2016

41 1500000000336 PUSKESMAS SUMOWONO JL.PAHLAWAN NO.15 KEC SUMOWONO 40575050 DINAS KESEHATAN KAB.SEMARANG PER/04/022015 RS.TRAUMA

CENTRE 01/03/2015 31/12/2015

42 1500000000343 PUSKESMAS SURUH JL RAYA SURUH PLUMBON KEC SURUH 2882262DINAS KESEHATAN KAB.SEMARANG PER/04/022015

RS.TRAUMA CENTRE 01/03/2015 31/12/2015

43 1500000000343 PUSKESMAS SURUH JL RAYA SURUH PLUMBON KEC SURUH 2882262 DINAS KESEHATAN KAB.SEMARANG


12/02/2016 31/12/2016

44 1500000000342 PUSKESMAS SUSUKAN JL RAYA SUSUKAN NO.96 KEC SUSUKAN 615066 DINAS KESEHATAN KAB SEMARANG


01/03/2015 31/12/2015

45 1500000000342 PUSKESMAS SUSUKAN JL RAYA SUSUKAN NO.96 KEC SUSUKAN 615066DINAS KESEHATAN KAB SEMARANG PER/07/012016

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

46 1500000000344 PUSKESMAS TENGARANJL RAYA SALATIGA SOLO KM 9 KEC. TENGARAN

DINAS KESEHATAN KAB.SEMARANG PER/07/012016

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

47 1500000000344 PUSKESMAS TENGARANJL RAYA SALATIGA SOLO KM 9 KEC. TENGARAN



01/03/2015 31/12/2015

48 7-1990928198 PUSKESMAS TUNTANG JL FATMAWATI NO.47, KEC TUNTANG 50131 0298340007



12/02/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


325 / 44607-11-201606:23:31



IKS


49 7-2009013889 PUSKESMAS UNGARAN JL AHMAD YANI NO 2-3 KEC UNGARAN KAB SEMARANG 50511 DINAS KESEHATAN KAB

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

50 7-3797360003 RS PARU DR. ARIO WIRAWAN SALATIGA JL HASANUDIN 806 50711 029832613

0

KEMENKES RI DIRJEN BINA UPAYA KESEHATAN


51 1400000000016 RS PURI ASIH JL JEND.SUDIRMAN NO. 169 323209 DR MUFTI SIRADJ,SPOG PER/18/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

52 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

53 1400000000019 RSUD AMBARAWA JL KARTINI NO. 101 AMBARAWA 591020 PEMDA KAB SEMARANG PER/02/012016 RS.TRAUMA CENTRE 12/01/2016 31/12/2016

54 1400000000019 RSUD AMBARAWA JL KARTINI NO. 101 AMBARAWA 591020 PEMDA KAB SEMARANG PER/16/122014RS.TRAUMA CENTRE 01/01/2015 31/12/2015

55 7-1395288578 RSUD KOTA SALATIGA JL OSAMALIKI NO. 19 SALATIGA 50721 PEMKOT SALATIGA PER/03/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

56 1400000000101 RSUD KOTA SALATIGA JL OSAMALIKI NO. 19 324074 PEMDA KOTA SALATIGA PER/17/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

57 1400000000018 RSUD UNGARAN JL DIPONEGORO NO. 125 UNGARAN 6921006 PEMDA KAB.SEMARANG PER/01/012016RS.TRAUMA CENTRE 12/01/2016 31/12/2016

58 1400000000018 RSUD UNGARAN JL DIPONEGORO NO. 125 UNGARAN 6921006 PEMDA KAB.SEMARANG PER/15/122014RS.TRAUMA CENTRE 01/01/2015 31/12/2015

KANTOR CABANG : L11- KANTOR CABANG SEMARANG KALIGAWE


Periode : 01/01/2015 s/d 31/10/2016


326 / 44607-11-201606:23:31



IKS


1 1500000001891 KLINIK 24 JAM DELIMA SEHAT JL FATMAWATI NO 21A SEMARANG 50111 6734367 DR. DODI WITJAKSONO PER / 27 /

072015RS.TRAUMA CENTRE 01/07/2015 31/12/2015

2 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

3 1500000001494 KLINIK KAWAN SEJATI DS KARANGSARI RT 01/04 KARANGTENGAHDEMAK

59511 089671458335

NINDYA ANGGI SINANTARA

PER / 19 / 062015

RS.TRAUMA CENTRE

01/06/2015 31/12/2015

4 1500000001494 KLINIK KAWAN SEJATI DS KARANGSARI RT 01/04 KARANGTENGAHDEMAK

59511 089671458335

NINDYA ANGGI SINANTARA


11/01/2016 31/12/2016

5 7-3591506615 KLINIK PHC PEDURUNGAN SEMARANG

JL WOLTERMONGINSIDI NO 93, PEDURUNGAN, SEMARANG 50113 024671446

5 DR. SWASTY, SP.,M. PER/14/052016 RS.TRAUMA CENTRE 01/06/2016 03/05/2018

6 1500000000967KLINIK PHC PEDURUNGAN SEMARANG

JL WOLTERMONGINSIDI NO 93, PEDURUNGAN, SEMARANG 6714465 DR. SWASTY, SP.,M.

PER / 12 / 052015

RS.TRAUMA CENTRE 04/05/2015 03/05/2016

7 1500000000921 KLINIK PHC TANJUNG EMASSEMARANG

JL. USMAN JANATIN NO 8 SEMARANG 50171 3549735 DR. DIAH KARI ARTATI, M.KES

PER / 12 / 052015

RS.TRAUMA CENTRE

04/05/2015 03/05/2016

8 1500000000921 KLINIK PHC TANJUNG EMASSEMARANG

JL. USMAN JANATIN NO 8 SEMARANG 50171 3549735 DR. DIAH KARI ARTATI, M.KES


26/05/2016 31/12/2017

9 1500000001534KLINIK PRATAMA DWI PUSPITA KALIGAWE

JL. RAYA KALIGAWE KM 7 NO 9 TRIMULYOSEMARANG 50111

082180099759 HJ. ANISFA BAKAR

PER / 23 / 062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

10 1500000001534KLINIK PRATAMA DWI PUSPITA KALIGAWE

JL. RAYA KALIGAWE KM 7 NO 9 TRIMULYOSEMARANG 50111

082180099759 HJ. ANISFA BAKAR PER/12/012016

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

11 1500000001532KLINIK PRATAMA DWI PUSPITA KARANGAWEN

JL. BRAMBANG NO 217 RT 05/02 BRAMBANG - DEMAK

59511082180099759

HJ. ANISFA BAKAR PER/10/012016RS.TRAUMA CENTRE

11/01/2016 31/12/2016

12 1500000001532 KLINIK PRATAMA DWI PUSPITA KARANGAWEN

JL. BRAMBANG NO 217 RT 05/02 BRAMBANG - DEMAK

59511 082180099759

HJ. ANISFA BAKAR PER / 21 / 062015

RS.TRAUMA CENTRE

01/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


327 / 44607-11-201606:23:31



IKS


13 1500000001533 KLINIK PRATAMA DWI PUSPITA PEDURUNGAN

JL. BRIG.JEND. SUDIARTO NO 512 SEMARANG 50111 082180099

759 HJ. ANISFA BAKAR PER/11/012016 RS.TRAUMA CENTRE 11/01/2016 31/12/2016

14 1500000001533 KLINIK PRATAMA DWI PUSPITA PEDURUNGAN

JL. BRIG.JEND. SUDIARTO NO 512 SEMARANG 50111 082180099

759 HJ. ANISFA BAKAR PER / 22 / 062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

15 1400000000261 KLINIK PRATAMA NAYAKA HUSADA 03

JL RAYA KALIGAWE KM 5,5 50118 70572297 PT NAYAKA ERA HUSADA SEMARANG


11/01/2016 31/12/2016


JL RAYA KALIGAWE KM 5,5 50118 70572297 PT NAYAKA ERA HUSADA SEMARANG

PER / 04 / 012015

RS.TRAUMA CENTRE

01/01/2015 31/12/2015


JL SEMARANG-DEMAK KM 15 WONOKERTOKARANGTENGAH DEMAK 59511 7605621 PT NAYAKA ERA

HUSADA SEMARANGPER / 16 / 062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015


JL SEMARANG-DEMAK KM 15 WONOKERTOKARANGTENGAH DEMAK 59511 7605621

PT NAYAKA ERA HUSADA SEMARANG PER/08/012016

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


JL SULTAN FATAH NO 47 DEMAK 59511 7605621 PT NAYAKA ERA HUSADA SEMARANG

PER / 17 / 062015

RS.TRAUMA CENTRE

01/06/2015 31/12/2015


JL SULTAN FATAH NO 47 DEMAK 59511 7605621 PT NAYAKA ERA HUSADA SEMARANG


11/01/2016 31/12/2016

21 1500000001807KLINIK PRATAMA RAWAT INAP KELUARGA SAKINAH

JL TELAGA KENCANA RAYA NO 15 BATURSARI MRANGGEN DEMAK 50111 76580381 DR. AISYAH LAHDJI

PER / 24 / 062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

22 1500000001807KLINIK PRATAMA RAWAT INAP KELUARGA SAKINAH

JL TELAGA KENCANA RAYA NO 15 BATURSARI MRANGGEN DEMAK 50111 76580381 DR. AISYAH LAHDJI PER/14/012016

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

23 1500000001539KLINIK PRATAMA SAYUNG HUSADA DEMAK

JL. RAYA SAYUNG KM 10 SAYUNG - DEMAK 59511 6591137 DR. FUAD ALHAMIDY PER/13/012016RS.TRAUMA CENTRE

11/01/2016 31/12/2016

24 1500000001539 KLINIK PRATAMA SAYUNG HUSADA DEMAK

JL. RAYA SAYUNG KM 10 SAYUNG - DEMAK 59511 6591137 DR. FUAD ALHAMIDY PER / 20 / 062015

RS.TRAUMA CENTRE

01/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


328 / 44607-11-201606:23:31



IKS


25 1500000001333 KLINIK PRATAMA SEHAT UTAMA

JL. MEDOHO RAYA NO 21 SAMBIREJO SEMARANG 50111 6719222 HJ. SRI WAHYUNI

MAHMUD, AMPER / 18 / 062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

26 1500000001333 KLINIK PRATAMA SEHAT UTAMA

JL. MEDOHO RAYA NO 21 SAMBIREJO SEMARANG 50111 6719222 HJ. SRI WAHYUNI

MAHMUD, AM PER/06/012016 RS.TRAUMA CENTRE 11/01/2016 31/12/2016

27 1500000001035 KLINIK PUCANG ANOM MEDIKA

JL PUCANG ANOM RAYA NO 30, MRANGGEN, DEMAK

59511 76743362 DR. RIANA VITA PER/18/052016 RS.TRAUMA CENTRE

26/05/2016 31/12/2017

28 1500000001035 KLINIK PUCANG ANOM MEDIKA

JL PUCANG ANOM RAYA NO 30, MRANGGEN, DEMAK

59511 76743362 DR. RIANA VITA PER / 13 / 052015

RS.TRAUMA CENTRE

04/05/2015 03/05/2016

29 1300000000006 RS ISLAM NU DEMAK JL JOGOLOYO NO 09 DEMAK 59511 685723 DR NUNUK SRI LESTARI PER / 03 / 012015

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

30 1300000000006 RS ISLAM NU DEMAK JL JOGOLOYO NO 09 DEMAK 59511 685723 DR NUNUK SRI LESTARI PER/02/012016RS.TRAUMA CENTRE 11/01/2016 31/12/2016

31 1100000000006 RS ISLAM SULTAN AGUNG JL RAYA KALIGAWE KM 4 SEMARANG 50112 6580019 DR MASYHUDI,MSI PER/01/012016 RS.TRAUMA CENTRE

11/01/2016 31/12/2017

32 1100000000006 RS ISLAM SULTAN AGUNG JL RAYA KALIGAWE KM 4 SEMARANG 50112 6580019 DR MASYHUDI,MSI PER / 01 / 012015

RS.TRAUMA CENTRE

01/01/2015 31/12/2015

33 1300000000033 RS PANTI WILASA CITARUM JL CITARUM NO 98 SEMARANG 50113 3542224-5 DR SUSETYO, SPA PER/03/012016RS.TRAUMA CENTRE 11/01/2016 31/12/2016

34 1300000000033 RS PANTI WILASA CITARUM JL CITARUM NO 98 SEMARANG 50113 3542224-5 DR SUSETYO, SPAPER / 02 / 012015

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

35 1400000000402 RSUD SUNAN KALIJAGA JL. SULTAN FATAH 669/50 DEMAK 59511 685018 RSUD KAB. DEMAK PER/05/012016RS.TRAUMA CENTRE

11/01/2016 31/12/2016

KANTOR CABANG : N00- KANTOR CABANG SURABAYA KARIMUNJAWA


Periode : 01/01/2015 s/d 31/10/2016


329 / 44607-11-201606:23:31



IKS


1 1500000000715 ANUGERAH KARYA MEDIKACEMENGKALANG SIDOARJO

RUKO PURI INDAH BLOK 30,JATI-CEMENGKALANG-SIDOARJO

03171554259

SUSILO HENDROWARSITO PER/15/052015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

2 1500000000715 ANUGERAH KARYA MEDIKACEMENGKALANG SIDOARJO

RUKO PURI INDAH BLOK 30,JATI-CEMENGKALANG-SIDOARJO

03171554259

SUSILO HENDROWARSITO PER/09/012015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

3 1500000000717 ANUGERAH KARYA MEDIKADEMAK

JL. DEMAK 375 SURABAYA 0811305143

CV. ANUGERAH KARYA MEDIKA


01/05/2015 31/12/2015

4 1500000000717 ANUGERAH KARYA MEDIKADEMAK

JL. DEMAK 375 SURABAYA 0811305143

CV. ANUGERAH KARYA MEDIKA


01/01/2016 31/12/2016

5 1500000000720 ANUGERAH KARYA MEDIKAGUNUNGSARI JL. GUNUNGSARI NO.124 SURABAYA 5675589 CV. ANUGERAH KARYA


6 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

7 1500000000712 BP 14 JL. PUCANG ANOM TIMUR NO. 35 SURABAYA

70701255 DR SURANADI SUGANDA PER/09/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

8 1500000000712 BP 14 JL. PUCANG ANOM TIMUR NO. 35 SURABAYA

70701255 DR SURANADI SUGANDA PER/10/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

9 1500000001466 BRAIN CLINIC JL. SULAWESI NO.63 SURABAYA 5018800PT. NEURO SENTRA HUSADA PER/11/012016

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

10 1500000001466 BRAIN CLINIC JL. SULAWESI NO.63 SURABAYA 5018800PT. NEURO SENTRA HUSADA PER/26/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

11 1500000001555 DIT POL AIR JALAN INTAN NO.1 - TANJUNG PERAK. PER/06/062015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

12 1500000001030 KLINIK ABDI MULIA HR MUHAMMAD

JL HR MOHAMMAD KAV 401-403 SURABAYA

7319619 YAYASAN ABDI MULIA PER/20/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


330 / 44607-11-201606:23:31



IKS


13 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

14 1500000001031 KLINIK ABDI MULIA WISMA PERMAI

JL. WISMA PERMAI BARAT III/FP 12 SURABAYA

031-5944122 YAYASAN ABDI MULIA PER/21/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

15 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

16 1500000000719 KLINIK HEALTHY JL NGAGEL TIRTO 25-27 5040990 KLINIK BEDAH & PRAKTEK DR HEALTHY


01/01/2016 31/12/2016

17 1500000000719 KLINIK HEALTHY JL NGAGEL TIRTO 25-27 5040990 KLINIK BEDAH & PRAKTEK DR HEALTHY PER/12/052015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

18 1500000001071 KLINIK KENCANA MEDIKA JL. KENDANGSARI NO. 78 SURABAYA 8498880KLINIK KENCANA MEDIKA PER/22/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

19 1500000001071 KLINIK KENCANA MEDIKA JL. KENDANGSARI NO. 78 SURABAYA 8498880 KLINIK KENCANA MEDIKA


01/01/2016 31/12/2016

20 1500000000716 KLINIK MEDIS AMBENGAN JL.AMBENGAN 35 SURABAYA 0818322119

CV. KARYA PUTRA AMBENGAN


01/05/2015 31/12/2015

21 1500000000716 KLINIK MEDIS AMBENGAN JL.AMBENGAN 35 SURABAYA0818322119

CV. KARYA PUTRA AMBENGAN PER/15/012016

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

22 1500000001072 KLINIK MEDPOINT JL. RAYA LONTAR 229 SURABAYA 7524067 KLINIK MEDPOINT PER/23/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

23 1500000001072 KLINIK MEDPOINT JL. RAYA LONTAR 229 SURABAYA 7524067 KLINIK MEDPOINT PER/23/062015RS.TRAUMA CENTRE

01/07/2015 31/12/2015

24 1500000001072 KLINIK MEDPOINT JL. RAYA LONTAR 229 SURABAYA 7524067 KLINIK MEDPOINT PER/16/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


331 / 44607-11-201606:23:31



IKS


25 1500000001487 KLINIK MODERN DASA MEDIKA JL. DIPONEGORO NO 161-163 SURABAYA 5677088

PT.PERKEBUNAN NUSANTARA X (PERSERO)


26 1500000001487 KLINIK MODERN DASA MEDIKA JL. DIPONEGORO NO 161-163 SURABAYA 5677088

PT.PERKEBUNAN NUSANTARA X (PERSERO)


27 1400000000445 KLINIK NAYAKA HUSADA 15 JL RAYA KRIKILAN NO 259 DRIYOREJO GRESIK



01/01/2016 31/12/2016

28 1400000000445 KLINIK NAYAKA HUSADA 15 JL RAYA KRIKILAN NO 259 DRIYOREJO GRESIK



01/01/2015 31/12/2015

29 1400000000450 KLINIK NAYAKA HUSADA 24 JL RA KARTINI NO 236 C-9 KEBOMAS GRESIK 7887273 PT NAYAKA ERA


30 1400000000450 KLINIK NAYAKA HUSADA 24JL RA KARTINI NO 236 C-9 KEBOMAS GRESIK 7887273


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

31 1400000000449 KLINIK NAYAKA HUSADA 61 RUKO SEPANJANG TOWN HOUSE C1-C3 JL KALIJATEN



01/01/2015 31/12/2015

32 1400000000449 KLINIK NAYAKA HUSADA 61 RUKO SEPANJANG TOWN HOUSE C1-C3 JL KALIJATEN



01/01/2016 31/12/2016

33 1500000000713 KLINIK PRATAMA 65 JL. GUBENG KERTAJAYA X1/38 SURABAYA08883535666

DR ADRIANUS MICHAEL FOEH PER/10/052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

34 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

35 1500000000718KLINIK PRATAMA ALAMANDA

JL. DINOYO NO.20-II 5677767 CV. INTI PRATAMA PER/11/052015RS.TRAUMA CENTRE

01/05/2015 31/12/2015

36 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 : 01/01/2015 s/d 31/10/2016


332 / 44607-11-201606:23:31



IKS


37 1400000000443 KLINIK PRATAMA NAYAKA 02 JL MASTRIP NO 150 KEBRAON SURABAYA 7887273 PT NAYAKA ERA


38 1400000000443 KLINIK PRATAMA NAYAKA 02 JL MASTRIP NO 150 KEBRAON SURABAYA 7887273 PT NAYAKA ERA



JL CENDRAWASIH NO 28B 7887273 PT NAYAKA ERA HUSADA


01/01/2016 31/12/2016


JL CENDRAWASIH NO 28B 7887273 PT NAYAKA ERA HUSADA


01/01/2015 31/12/2015

41 1400000000446 KLINIK PRATAMA NAYAKA HUSADA 03 JL ASEM ROWO KALI NO 1 7887273 PT NAYAKA ERA


42 1400000000446KLINIK PRATAMA NAYAKA HUSADA 03 JL ASEM ROWO KALI NO 1 7887273


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


JL PANDEGILING NO 117A 7887273 PT NAYAKA ERA HUSADA


01/01/2015 31/12/2015


JL PANDEGILING NO 117A 7887273 PT NAYAKA ERA HUSADA


01/01/2016 31/12/2016

45 1400000000448KLINIK PRATAMA NAYAKA HUSADA 07 JL TANDES ASRI NO 64 7887273


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

46 1400000000448KLINIK PRATAMA NAYAKA HUSADA 07 JL TANDES ASRI NO 64 7887273


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


JL KALI RUNGKUT NO 52 7887273PT NAYAKA ERA HUSADA


01/01/2016 31/12/2016


JL KALI RUNGKUT NO 52 7887273 PT NAYAKA ERA HUSADA


01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


333 / 44607-11-201606:23:31



IKS


49 1500000001483 KLINIK PRATAMA PG KREMBOONG DESA KREMBOONG SIDOARJO 081332074

648 PTPN X PER/27/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

50 1500000001483 KLINIK PRATAMA PG KREMBOONG DESA KREMBOONG SIDOARJO 081332074

648 PTPN X PER/24/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

51 1500000001484 KLINIK PRATAMA PG TOELANGAN

DESA TULANGAN SIDOARJO PTPN X PER/27/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

52 1500000001484 KLINIK PRATAMA PG TOELANGAN

DESA TULANGAN SIDOARJO PTPN X PER/24/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

53 1500000001485 KLINIK PRATAMA PG WATOETOELIS

DESA TEMU KECAMATAN PRAMBON SIDOARJO

081332074648 PTPN X PER/27/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

54 1500000001485KLINIK PRATAMA PG WATOETOELIS

DESA TEMU KECAMATAN PRAMBON SIDOARJO

081332074648 PTPN X PER/24/012016

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

55 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

56 1500000001486 KLINIK ST.VINCENTIUS A PAULO (KARAH)

JL. KARAH NO.200 SURABAYA 5677562 YAYASAN ARNOLDUS PER/28/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

57 1500000001029KLINIK 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

58 1500000001029KLINIK UTAMA KASIH KARUNIA

JL. RAYA SATELIT BARAT AS NO.1 SURABAYA 7327688

YAYASAN KASIH KARUNIA PER/18/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

59 1500000001558POLIKLINIK BIDDOKKES A. YANI (SATKES MERTOJOSO)

JL. A. YANI NO. 116 SURABAYA PER/06/062015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

60 1500000001556 POLRES PELABUHAN TANJUNG PERAK

JALAN KALIANGET NO. 1, SURABAYA, JAWA TIMUR 60165


01/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


334 / 44607-11-201606:23:31



IKS


61 1500000001559 POLRESTABES SURABAYA JL. SIKATAN 1, SURABAYA PER/06/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

62 7-2646874297 RS ADI HUSADA KAPASARI JL. KAPASARI 97-101 SURABAYA 60141 0313764555

PERKUMPULAN ADI HUSADA PER/28/032016 RS.TRAUMA

CENTRE 24/03/2016 31/12/2016

63 1500000000478 RS BHAKTI DHARMA HUSADA

JL RAYA KENDUNG NO 115-117 7404444 PEMERINTAH KOTA SURABAYA


01/04/2015 31/12/2015

64 1500000000478 RS BHAKTI DHARMA HUSADA

JL RAYA KENDUNG NO 115-117 7404444 PEMERINTAH KOTA SURABAYA


01/01/2016 31/12/2016

65 0700000000013 RS BHAYANGKARA HS SAMSOERI M JL. A YANI NO. 116 SURABAYA 8292227 POLDA JATIM PER/02/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

66 0700000000013RS 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

67 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

68 1500000000714 RS MARINIR EWA PANGALILA GUNUNGSARI

JL GOLF I NO 1A SURABAYA 031-5663539

TNI ANGKATAN LAUT PER/17/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

69 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

70 1500000001385 RS MATA UNDAAN JL UNDAAN KULON 17-19 SURABAYA 5343806 RS MATA UNDAAN PER/24/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

71 1500000000549 RS TINGKAT III BRAWIJAYA JL KESATRIAN NO 17 5611272 KODAM V BRAWIJAYA PER/07/042015RS.TRAUMA CENTRE

01/04/2015 31/12/2015

72 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


Periode : 01/01/2015 s/d 31/10/2016


335 / 44607-11-201606:23:31



IKS


73 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

74 1500000000187 RS TNI AU SOEMITRO SURABAYA JL. SERAYU NO 17 SURABAYA 5662593 TNI AU PER/05/022015 RS.TRAUMA

CENTRE 01/02/2015 31/12/2015

75 1500000001384 RS UNIVERSITAS AIRLANGGA

KAMPUS C MULYOREJO UNIVERSITAS AIRLANGGA SBY

8439473 UNIVERSITAS AIRLANGGA


01/01/2016 31/12/2016

76 1500000001384 RS UNIVERSITAS AIRLANGGA

KAMPUS C MULYOREJO UNIVERSITAS AIRLANGGA SBY

8439473 UNIVERSITAS AIRLANGGA


01/06/2015 31/12/2015

77 7-2646874299 RS WILLIAM BOOTH SURABAYA JL. DIPONEGORO NO.34 SURABAYA 60241 031567891

7

YAYASAN PELAYANAN KESEHATAN BALA KESELAMATAN


78 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

79 1500000000711RS.DKT GUBENG POJOK-BANTUAN 05.08.05 SURABAYA

JL. GUBENG POJOK NO.21 5310069 DRG.OUTI PER/08/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

80 7-2743409383 RSUD DR SOETOMO JL. MAYJEND PROF. DR. MOESTOPO NO. 6 - 8 SURABAYA

60286 5501770-72 PEMPROV JATIM PER/27/032016 RS.TRAUMA CENTRE

31/03/2016 31/12/2016

81 1400000000360RUMAH SAKIT SURABAYA MEDICAL SERVICE JL. KAPUAS NO.2 SURABAYA 5686161 YAYASAN PUJA HUSADA PER/23/012016

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

82 1400000000360RUMAH SAKIT SURABAYA MEDICAL SERVICE JL. KAPUAS NO.2 SURABAYA 5686161 YAYASAN PUJA HUSADA PER/03/012015

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

83 1500000001557 SAT BRIMOB JL. GRESIK 39 SURABAYA PER/06/062015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

84 7-2884678195 SILOAM HOSPITALS SURABAYA

JL. GUBENG NO 70 SURABAYA 60281 031 503 1333

PT. SILOAM INTERNATIONAL HOSPITALS SURABAYA


12/04/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


336 / 44607-11-201606:23:31


KANTOR CABANG : N01- KANTOR CABANG KEDIRI


IKS


1 1500000000732 BP SWASTA DAN BKIA SWASTA MITRA HUSADA

JLN. BROMO V NO.3 RT01 RW01 DS TUNJUNGREJO KEC.LOCERET KABUPATEN NGANJUK

IR. H. TEUKU ISMAIL PER/10/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

2 1400000000662 KLINIK ASFIYAK GRAHA MEDIKA

JL. KANDANGAN NO.63A DS KENCONG TENGAH KEC KEPUNG KABUPATEN KEDIRI 395066 PT. ASFIYAK GRAHA


3 1500000000731 KLINIK PRATAMA RAWAT JALAN MITRA 02

JL. IMAM BONJOL NO.2 DESA PELEM KEC.KERTOSONO KABUPATEN NGANJUK IR. H. TEUKU ISMAIL PER/09/052015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

4 1500000000730 KLINIK PRATAMA RAWAT JALAN MITRA HUSADA I

JLN. YOS SUDARSO NO.37 DS. TULUNGREJOKEC.PARE KABUPATEN KEDIRI

KLINIK PRATAMA RAWAT JALAN MITRA HUSADA I


5 1500000000933 KLINIK SURYA PRIMA HUSADA

JL. RAYA KUNJANG RT1 RW2 KUNJANG KABUPATEN KEDIRI

7660694 KLINIK SURYA PRIMA HUSADA


01/06/2015 31/12/2015

6 1500000001620 POLIKLINIK POLRES KEDIRI JL. PB SUDIRMAN NO. 56 PARE POLIKLINIK POLRES KEDIRI PER/18/062015 RS.TRAUMA

CENTRE 01/07/2015 31/12/2015

7 1500000001619POLIKLINIK POLRES KOTA KEDIRI JLN. BRAWIJAYA NO. 25 KEDIRI

POLIKLINIK POLRES KOTA KEDIRI PER/17/062015

RS.TRAUMA CENTRE 01/07/2015 31/12/2015

8 1500000001622POLIKLINIK POLRES NGANJUK

JALAN GATOT SUBROTO NO. 116, NGANJUKPOLIKLINIK POLRES NGANJUK


01/07/2015 31/12/2015

9 1000000000008 RS BHAYANGKARA KEDIRI JL.KOMBES POL. DURYAT NO. 17 KEDIRI POLRI PER/18/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

10 1000000000008 RS BHAYANGKARA KEDIRI JL.KOMBES POL. DURYAT NO. 17 KEDIRI POLRI PER/33/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

11 07189RS BHAYANGKARA NGANJUK JL. ABDUL RAHMAN SALEH NO. 52-56 3218896 PER/23/122015

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

12 04783 RS. BHAYANGKARA KEDIRI JL. KOMBES POL.DURYAT NO.17 KEDIRI POLRIPER/5113/122015

RS.TRAUMA CENTRE 28/12/2015 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


337 / 44607-11-201606:23:31



IKS


13 1500000000725 RSU AURA SYIFA JL. JOYOBOYO NO. 42 DLOPO KEC. NGASEMKABUPATEN KEDIRI 671939 RSU AURA SYIFA PER/07/052015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

14 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

15 1500000001258 RSU MUHAMMADIYAH SURYA MELATI

JL. RAYA NGADILUWIH WATES KM 10 DS. NGLETIH KANDAT

441748 RSU MUHAMMADIYAH SURYA MELATI


01/06/2015 31/12/2015

16 0800000000031 RSUD GAMBIRAN JL.K.H.WAHID HASYIM NO 64 773097 DR.ENDANG WAHYU L,MARS


01/01/2016 31/12/2016

17 0800000000031 RSUD GAMBIRAN JL.K.H.WAHID HASYIM NO 64 773097 DR.ENDANG WAHYU L,MARS PER/19/122014 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

18 1500000001542 RSUD KABUPATEN KEDIRIJLN. PAHLAWAN KUSUMA BANGSA NO. 1 PARE KEDIRI 391718

RSUD KABUPATEN KEDIRI PER/29/122015

RS.TRAUMA CENTRE 20/09/2016 31/12/2016

19 1500000001542 RSUD KABUPATEN KEDIRI JLN. PAHLAWAN KUSUMA BANGSA NO. 1 PARE KEDIRI

391718 RSUD KABUPATEN KEDIRI


01/07/2015 31/12/2015

20 1400000000564 RSUD KERTOSONO JL. SUPRIYADI NO. 29 KERTOSONO 551118 RUMAH SAKIT UMUM DAERAH KERTOSONO


01/01/2015 31/12/2015

21 1400000000564 RSUD KERTOSONO JL. SUPRIYADI NO. 29 KERTOSONO 551118RUMAH SAKIT UMUM DAERAH KERTOSONO PER/25/122015

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

22 1500000000863RUMAH SAKIT BEDAH ARGAHUSADA

DS BRANGGAHAN KEC NGADILUWIH KABUPATEN KEDIRI 476376

YAYASAN ARGA HUSADA UTAMA PER/11/052015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

23 1500000000863RUMAH SAKIT BEDAH ARGAHUSADA

DS BRANGGAHAN KEC NGADILUWIH KABUPATEN KEDIRI

476376YAYASAN ARGA HUSADA UTAMA


01/01/2016 31/12/2016

24 1400000000421 RUMAH SAKIT BHAYANGKARA NGANJUK

JL. ABDUL RAHMAN SALEH NO. 56 NGANJUK 64415

3218896 KEPOLISIAN REPUBLIK INDONESIA


01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


338 / 44607-11-201606:23:31



IKS


25 1500000000940 RUMAH SAKIT HVA TOELOENGREDJO

JL. A YANI NO. 25 PARE KABUPATEN KEDIRI 391047 RS PTP XXI

TOELOENGREDJO PER/13/052015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

26 1500000000940 RUMAH 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

27 1400000000206RUMAH SAKIT MUHAMMADIYAH AHMAD DAHLAN

JL. GATOT SUBROTO 84 KOTA KEDIRI 773115MKKM PD MUHAMMADIYAH KOTA KEDIRI


01/01/2015 31/12/2015

28 1400000000206RUMAH SAKIT MUHAMMADIYAH AHMAD DAHLAN

JL. GATOT SUBROTO 84 KOTA KEDIRI 773115MKKM PD MUHAMMADIYAH KOTA KEDIRI


01/01/2016 31/12/2016

29 1500000000723RUMAH SAKIT MUHAMMADIYAH SITI KHODIJAH

JL. DR.SUTOMO NO.322 SUKOREJO KEC.GURAH KABUPATEN KEDIRI 545481

RUMAH SAKIT MUHAMMADIYAH SITI KHODIJAH


30 1500000000723RUMAH SAKIT MUHAMMADIYAH SITI KHODIJAH

JL. DR.SUTOMO NO.322 SUKOREJO KEC.GURAH KABUPATEN KEDIRI 545481

RUMAH SAKIT MUHAMMADIYAH SITI KHODIJAH


31 7-4678364633 RUMAH SAKIT UMUM LIRBOYO

JL. DR. SAHARDJO-CAMPUREJO 64117 0354778165

YAYASAN PONPES HIDAYATUL MUBTADI-EN


08/09/2016 31/12/2016

32 1500000001259 RUMAH SAKIT UMUM LIRBOYO

JL. DR. SAHARDJO CAMPUREJO 778165YAYASAN PONPES HIDAYATUL MUBTADI-EN


01/06/2015 31/12/2015

33 7-4662995227RUMAH SAKIT UMUM MUHAMMADIYAH SURYA MELATI

JALAN RAYA NGADILUWIH WATES KM 10 DESA NGLETIH

64173 0354441748

MAJELIS PEMBINA KESEHATAN UMUM PIMPINAN DAERAH MUHAMMADIYAH KABUPATEN KEDIRI


08/09/2016 31/12/2016

34 1500000001637RUMKIT TK IV (DKT) TNI AD KEDIRI

JL. MAYJEN SUNGKONO NO. 44 KEDIRI 687801RUMKIT TK IV (DKT) TNI AD KEDIRI


01/07/2015 31/12/2015

35 1500000000659UNIT PELAKSANA TEKNIS PELATIHAN KERJA KEDIRI

DS. GEDANGSEWU KEC. PARE KABUPATEN KEDIRI

391583

PEMERINTAH PROVINSI JAWA TIMUR DINAS TENAGA KERJA TRANSMIGRASI DAN KEPENDUDUKAN


01/05/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


339 / 44607-11-201606:23:31


KANTOR CABANG : N02- KANTOR CABANG MALANG


IKS


1 7-2441622873 G AND G HEALTH CLINIC JLN. TERUSAN KAWI NO. 9 KAV. 9 65119 341 568527 DR. FM. VALENTINA, SH M. HUM


11/03/2016 31/12/2016

2 7-4303480323 KLINIK HUSADA PRIMA JLN. R. TUMENGGUNG SURYO NO.45 65121 341479370 TEGUH SUBELO, SE PER/ 28/042016 RS.TRAUMA CENTRE 16/08/2016 31/12/2019

3 1500000000919 KLINIK NAYAKA ERA HUSADA 02 JL. RAYA PAKIS KEMBAR NO. 174 A PAKIS 796858 PT.NAYAKA ERA


4 1500000000919 KLINIK NAYAKA ERA HUSADA 02 JL. RAYA PAKIS KEMBAR NO. 174 A PAKIS 796858 PT.NAYAKA ERA

HUSADA PER/158I/052015 RS.TRAUMA CENTRE 19/05/2015 18/05/2016

5 1500000000916 KLINIK NAYAKA HUSADA 01 JL. A. YANI NO. 20 F BLIMBING 496261 PT.NAYAKA ERA HUSADA


20/05/2016 31/12/2019

6 1500000000916 KLINIK NAYAKA HUSADA 01 JL. A. YANI NO. 20 F BLIMBING 496261 PT.NAYAKA ERA HUSADA PER/158/052015 RS.TRAUMA

CENTRE 19/05/2015 18/05/2016

7 7-2738145733KLINIK NAYAKA HUSADA NO.05

JLN. RAYA JABUNG RT/ W 003/002 DESA JABUNG KECAMATAN JABUNG 65155 341794735

PT NAYAKA ERA HUSADA PER/18//032016

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

8 1500000001672 KLINIK POLRES BARU JLN. HASANUDDIN NO.1 JUNREJO PER/177/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

9 1500000001673 KLINIK POLRES MALANG JL PAHLAWAN TRIP NO 1 65111 551356 DR AKHMAD PRABOWO PER/178/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

10 7-3513252503 KLINIK RAWAT INAP CAKRAHUSADA

JLN. SEMERU NO.2 TUREN 65175 341827295 PT CAKRA MANDIRI PRATAMA INDONESIA


25/05/2016 31/12/2019

11 1500000001676KLINIK RAWAT JALAN MUTIARA SEHAT

PERUM PTP 23 BLOK I 27 RT 01 RW 04 DS BANJARARUM SINGOSARI 65153 4949699 LOVI KRISADI ENDARI PER/27/062016

RS.TRAUMA CENTRE 30/06/2016 31/12/2019

12 1500000001676KLINIK RAWAT JALAN MUTIARA SEHAT

PERUM PTP 23 BLOK I 27 RT 01 RW 04 DS BANJARARUM SINGOSARI 65153 4949699 LOVI KRISADI ENDARI PER/180/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


340 / 44607-11-201606:23:31



IKS


13 7-2553159943 KLINIK SEHAT24 JLN. RAYA KARANGPLOSO KEPUHARJO RUKO BALITAS KAV. 7 65152 341

5034129 SUJIATI JS PER/17/032016 RS.TRAUMA CENTRE 17/03/2016 31/12/2016

14 7-5072165013RS HERMINA TANGKUBANPRAHU MALANG

JLN. TANGKUBAN PERAHU NO 31-33 65111 341322525 DR. HASMORO PER/34/092016 RS.TRAUMA CENTRE 07/10/2016 31/12/2018

15 1300000000016 RS. BAPTIS BATU JL. RAYA TLEKUNG NO.1 JUNREJO 594161 YAYASAN BAPTIS INDONESIA


01/01/2015 31/12/2015

16 1300000000016 RS. BAPTIS BATU JL. RAYA TLEKUNG NO.1 JUNREJO 594161 YAYASAN BAPTIS INDONESIA


01/01/2016 31/12/2016

17 1200000000012 RS. BHAYANGKARA HASTA BRATA JL. RA KARTINI NO. 01 597023 PER/03/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

18 1200000000012RS. BHAYANGKARA HASTA BRATA JL. RA KARTINI NO. 01 597023 PER/03/012016

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

19 1200000000008 RS. WAVA HUSADA JL. PANGLIMA SUDIRMAN NO. 99 A DILEM KEPANJEN

393000 ABNASAMANHUDI SAUTIKA HUSADA PT


01/01/2016 31/12/2016

20 1200000000008 RS. WAVA HUSADA JL. PANGLIMA SUDIRMAN NO. 99 A DILEM KEPANJEN

393000 ABNASAMANHUDI SAUTIKA HUSADA PT


01/01/2015 31/12/2015

21 1500000000046 RSI GONDANGLEGI JL HAYAM WURUK NO 66 GONDANGLEGI 879047YAYASAN RS GONDANGLEGI

PER/04/01/012016

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

22 1500000000046 RSI GONDANGLEGI JL HAYAM WURUK NO 66 GONDANGLEGI 879047YAYASAN RS GONDANGLEGI PER/04/012015

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

23 7-3858835093RSJ DR. RADJIMAN WEDIODININGRAT LAWANG

JLN. JEND A. YANI SUMBER PORONG 65211 341429067KEMENTRIAN KESEHATAN


20/06/2016 31/12/2017

24 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


Periode : 01/01/2015 s/d 31/10/2016


341 / 44607-11-201606:23:31



IKS


25 1400000000002 RSU ISLAM MADINAH JL. RAYA SUKOSARI 32 KASEMBON 326688 YAY AL MADINAH PER/12/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

26 1200000000009 RSU. LAWANG MEDIKA JL. DR. CIPTO NO. 08 BEDALI LAWANG 426705 PT. DASA USAHA JAYA PER/05/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

27 1200000000009 RSU. LAWANG MEDIKA JL. DR. CIPTO NO. 08 BEDALI LAWANG 426705 PT. DASA USAHA JAYA PER/05/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

28 1200000000010 RSU. PRASETYA HUSADA JL. RAYA NGIJO NO. 25 KARANG PLOSO 460558 SUJIATI, SST,MM.KES PER/08/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

29 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

30 7-3039817013RSUD KANJURUHAN KEPANJEN JLN. PANJI NOMOR 100 65163 341395041

PEMERINTAH KABUPATEN MALANG PER/22/012016

RS.TRAUMA CENTRE 25/04/2016 20/12/2016

31 7-375291327 RSUD LAWANG JL RA KARTINI 5 LAWANG 65213 PEMERINTAH PER/183/092015 RS.TRAUMA CENTRE

02/12/2015 31/08/2016

32 7-375291327 RSUD LAWANG JL RA KARTINI 5 LAWANG 65213 PEMERINTAH PER/ 31/092016 RS.TRAUMA CENTRE

31/10/2016 31/12/2018

33 1500000000920RUMAH SAKIT BALA KESELAMATAN BOKOR JL. JEND. A. YANI NO. 91 TUREN 824002



34 1500000000920RUMAH SAKIT BALA KESELAMATAN BOKOR JL. JEND. A. YANI NO. 91 TUREN 824002



35 7-938470983RUMAH SAKIT DR. ETTY ASHARTO

JLN. SAJID NO.44 BATU 65313 341591054DR.RACHMAD ARI IRMAWAN


31/12/2015 31/08/2016

36 1500000001674 RUMAH SAKIT ISLAM MALANG

JL MT HARYONO 139 65144 551356 DR H TRIWAHYU SARWIYATA


23/08/2016 31/12/2019


Periode : 01/01/2015 s/d 31/10/2016


342 / 44607-11-201606:23:31



IKS


37 1500000001674 RUMAH SAKIT ISLAM MALANG JL MT HARYONO 139 65144 551356 DR H TRIWAHYU

SARWIYATA PER/179/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

38 1000000000011 RUMAH SAKIT MARSUDI WALUYO

JL.RAYA MONDOROKO KM 9 SINGOSARI MALANG 458919 DR.KRISTIWI

HANGGRIYANI PER/14/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

39 1000000000011 RUMAH SAKIT MARSUDI WALUYO

JL.RAYA MONDOROKO KM 9 SINGOSARI MALANG

458919 DR.KRISTIWI HANGGRIYANI


01/01/2015 31/12/2015

40 1000000000013 RUMAH SAKIT PANTI NIRMALA

JL.KEBALEN WETAN NO.8 331100 DRG.BENNY ANDOKO WIBISONO


01/01/2016 31/12/2016

41 1000000000013 RUMAH SAKIT PANTI NIRMALA JL.KEBALEN WETAN NO.8 331100 DRG.BENNY ANDOKO

WIBISONO PER/07/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

42 1000000000012RUMAH SAKIT PRIMA HUSADA

JL.BANJARARUM SELATAN NO 3 MONDOROKO-SINGOSARI MALANG 458679 DR.SADI HARIONO PER/09/012016

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

43 1000000000012 RUMAH SAKIT PRIMA HUSADA

JL.BANJARARUM SELATAN NO 3 MONDOROKO-SINGOSARI MALANG

458679 DR.SADI HARIONO PER/09/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

44 1200000000011 RUMAH SAKIT UMUM BEN MARI

JL. RAYA KENDAL PAYAK NO 17 PAKISAJI 837777 PT. RS BEN MARI PER/02/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

45 1200000000011RUMAH 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

46 1400000000001RUMAH SAKIT UMUM DAERAH DR. SAIFUL ANWAR

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

47 1400000000001RUMAH SAKIT UMUM DAERAH DR. SAIFUL ANWAR

JL. JAKSA AGUNG SUPRAPTO 362101 PEMPROV JATIM PER/10/012015RS.TRAUMA CENTRE

01/01/2015 31/12/2015

48 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


Periode : 01/01/2015 s/d 31/10/2016


343 / 44607-11-201606:23:31


KANTOR CABANG : N03- KANTOR CABANG JEMBER


IKS


1 1500000001593 FKTP POLRES BONDOWOSO JL JEND A YANI 29 POLDA JATIM PER/12/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2017

2 1500000001592 FKTP POLRES JEMBER JL RA KARTINI 17 338044 POLDA JATIM PER/13/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2017

3 1500000001590 FKTP POLRES LUMAJANG JL ALUN ALUN UTARA 11 889022 POLDA JATIM PER/11/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2017

4 1500000000652 KLINIK ROLAS MEDIKA JL GAJAH MADA NO 15 PT ROLAS NUSANTARA MEDIKA JEMBER PER/06/042015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

5 1500000000652 KLINIK ROLAS MEDIKA JL GAJAH MADA NO 15 PT ROLAS NUSANTARA MEDIKA JEMBER


28/07/2016 31/12/2018

6 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

7 1500000001561RS BHAYANGKARA TK III LUMAJANG

JL KYAI ILYAS NO 07 TOMPOKERSAN LUMAJANG 88646 POLDA JATIM PER/10/062015

RS.TRAUMA CENTRE 01/06/2016 31/05/2017

8 1500000001561RS BHAYANGKARA TK III LUMAJANG

JL KYAI ILYAS NO 07 TOMPOKERSAN LUMAJANG

88646 POLDA JATIM PER/10/062015RS.TRAUMA CENTRE

01/06/2015 31/05/2016

9 1500000001591 RS BINA SEHAT JL JAYA NEGARA 7 JEMBER 422701 YAYASAN BINA SEHAT PER/14/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

10 1500000001591 RS BINA SEHAT JL JAYA NEGARA 7 JEMBER 422701 YAYASAN BINA SEHAT PER/19/092016 RS.TRAUMA CENTRE

27/09/2016 31/12/2018

11 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

12 1400000000626 RS ISLAM LUMAJANG JL KYAI MUKSIN 19 LUMAJANG 887999DR R ELYUNAR DWI NUGROHO PER/20/122015

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


Periode : 01/01/2015 s/d 31/10/2016


344 / 44607-11-201606:23:31



IKS


13 7-1692033973 RS JEMBER KLINIK JALAN BEDADUNG NO.2 JEMBER LOR PATRANG JEMBER 68111 033148710

4 PT NUSANTARA MEDIKAUTAMA PER/05/012016 RS.TRAUMA

CENTRE 28/01/2016 31/12/2016

14 7-3883072673 RS WIJAYA KUSUMA LUMAJANG JL AHMAD YANI 149 LUMAJANG 67352 DR KOESWANDONO PER/13/052016 RS.TRAUMA

CENTRE 23/06/2016 31/12/2016

15 1500000000647 RSD DR SOEBANDI JL DR SOEBANDI NO 124 487441 PER/09/2016 RS.TRAUMA CENTRE

01/04/2016 31/12/2017

16 1500000000647 RSD DR SOEBANDI JL DR SOEBANDI NO 124 487441 PER/05/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

17 1400000000009 RSU KALIWATES JEMBER JL DIAH PITALOKA NO 4 A JEMBER 485967 PT ROLAS NUSANTARA MEDIKA PER/02/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

18 1400000000009 RSU KALIWATES JEMBER JL DIAH PITALOKA NO 4 A JEMBER 485967PT ROLAS NUSANTARA MEDIKA PER/21/122015

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

19 1400000000009 RSU KALIWATES JEMBER JL DIAH PITALOKA NO 4 A JEMBER 485967 PT ROLAS NUSANTARA MEDIKA


01/01/2015 31/12/2015

20 7-777708533 RSUD DR H KOESNADI BONDOWOSO

JLPIERE TENDEAN BONDOWOSO 00000 DR AGUS SUWARDJITO, M KES


01/10/2016 31/12/2018

21 7-777708533RSUD DR H KOESNADI BONDOWOSO JLPIERE TENDEAN BONDOWOSO 00000

DR AGUS SUWARDJITO, M KES PER/16/102015

RS.TRAUMA CENTRE 02/12/2015 30/09/2016

22 7-1938064553RSUD DR HARYOTO KAB LUMAJANG JL BASUKI RAHMAD NO 5 LUMAJANG 67311

0334881666 PEMPROV PER/007/022016

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

23 1500000000957RUMAH SAKIT DAERAH BALUNG

JL RAMBIPUJI 19 BALUNG PEMDA PER/011/042016RS.TRAUMA CENTRE

25/07/2016 31/12/2018

24 1500000000957 RUMAH SAKIT DAERAH BALUNG

JL RAMBIPUJI 19 BALUNG PEMDA PER/08/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


345 / 44607-11-201606:23:31



IKS


25 1500000000956 RUMAH SAKIT DAERAH KALISAT JL MH THAMRIN 31 KALISAT JEMBER 233388695 PEMDA PER/12/042016 RS.TRAUMA

CENTRE 11/08/2016 31/12/2018

26 1500000000956 RUMAH SAKIT DAERAH KALISAT JL MH THAMRIN 31 KALISAT JEMBER 233388695 PEMDA PER/07/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

27 7-4563450153 RUMAH SAKIT MITRA MEDIKA BONDOWOSO

JL. HOS COKROAMINOTO NO. 98 68211 DR. YAHYA AMAR, SP.PD.,FINASIM


31/08/2016 31/12/2018

28 7-4338295399 RUMKIT TK III BALADHIKA HUSADA JEMBER

JL. PB. SUDIRMAN NO. 45 JEMBER 68111 KESDAM V BRAWIJAYA PER/15/082016 RS.TRAUMA CENTRE

11/08/2016 31/12/2018

KANTOR CABANG : N04- KANTOR CABANG PASURUAN


IKS


1 1500000001062 BP JAMSOSTEK 22 JL. PUCANGSARI, SENGONAGUNG, PURWOSARI

7764043 CV CITRA MEDIKA IKS/09/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

2 1500000001062 BP JAMSOSTEK 22JL. PUCANGSARI, SENGONAGUNG, PURWOSARI 7764043 CV CITRA MEDIKA IKS/25/052015

RS.TRAUMA CENTRE 25/05/2015 31/12/2015

3 1500000001061 BP JAMSOSTEK 51 JL. TONGKOL NO. 2C, BANGIL 747731 CV CITRA MEDIKA IKS/10/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

4 1500000001061 BP JAMSOSTEK 51 JL. TONGKOL NO. 2C, BANGIL 747731 CV CITRA MEDIKA IKS/25/052015RS.TRAUMA CENTRE

25/05/2015 31/12/2015

5 1500000001651 FKTP POLRES KAB PASURUAN

JL. DR.SUTOMO NO.1, BANGIL POLRI PER/06/062015 RS.TRAUMA CENTRE

22/06/2015 21/06/2017


Periode : 01/01/2015 s/d 31/10/2016


346 / 44607-11-201606:23:31



IKS


6 1500000001649 FKTP POLRES KOTA PASURUAN JL. BALAI KOTA NO.3 POLRI PER/06/062015 RS.TRAUMA

CENTRE 22/06/2015 21/06/2017

7 1500000001644 FKTP POLRES KOTA PROBOLINGGO JL. ANGGREK NO.2 POLRI PER/06/062015 RS.TRAUMA

CENTRE 22/06/2015 21/06/2017

8 1500000001647 FKTP POLRES PROBOLINGGO

JL. DR. M.SALEH NO.24 POLRI PER/06/062015 RS.TRAUMA CENTRE

22/06/2015 21/06/2017

9 1500000001336 KLINIK CITRA 10 JL. RAYA JAPANAN, GG.BANDENG PRESATO NO.2, GEMPOL

854335 CV CITRA MEDIKA IKS/25/052015 RS.TRAUMA CENTRE

25/05/2015 31/12/2015

10 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

11 1500000001340 KLINIK CITRA 2 JL. RAYA DRINGU GG.MARGOMULYO NO.2 843346 CV CITRA MEDIKA IKS/25/052015RS.TRAUMA CENTRE 25/05/2015 31/12/2015

12 1500000001340 KLINIK CITRA 2 JL. RAYA DRINGU GG.MARGOMULYO NO.2 843346 CV CITRA MEDIKA IKS/15/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

13 1500000001339 KLINIK CITRA 6 JL. MASTRIP GG.KELAPA GADING NO. 43 4430181 CV CITRA MEDIKA IKS/14/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

14 1500000001339 KLINIK CITRA 6 JL. MASTRIP GG.KELAPA GADING NO. 43 4430181 CV CITRA MEDIKA IKS/25/052015RS.TRAUMA CENTRE 25/05/2015 31/12/2015

15 1500000001338 KLINIK CITRA PURWOSARI JL. RAYA PURWOSARI NO. 21, 612244 CV CITRA MEDIKA IKS/25/052015RS.TRAUMA CENTRE 25/05/2015 31/12/2015

16 1500000001338 KLINIK CITRA PURWOSARI JL. RAYA PURWOSARI NO. 21, 612244 CV CITRA MEDIKA IKS/13/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

17 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 : 01/01/2015 s/d 31/10/2016


347 / 44607-11-201606:23:31



IKS


18 1500000001337 KLINIK JAMSOSTEK CITRA 1 JL. RAYA NGOPAK NO. 8, REJOSO 482366 CV CITRA MEDIKA IKS/25/052015 RS.TRAUMA CENTRE 25/05/2015 31/12/2015

19 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

20 1500000001045 KLINIK MITRA 125 GG LONDO NO. 22A, JAGIL, GAMBIRAN, PRIGEN

881459 CV MITRA HUSADA IKS/23/052015 RS.TRAUMA CENTRE

25/05/2015 31/12/2015

21 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

22 1500000001040 KLINIK MITRA 82RUKO PERUM ISTANA BESTARI, JL. DR. WAHIDIN SUDIROHUSODO KEL. TAMANAN,KEC. BUGUL KIDUL,

6640508 CV. MITRA HUSADA IKS/23/052015 RS.TRAUMA CENTRE 25/05/2015 31/12/2015

23 1500000001044 KLINIK MITRA 91 JL. RAYA GONDANG LEGI NO. 04, BEJI 655291 CV MITRA HUSADA IKS/07/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

24 1500000001044 KLINIK MITRA 91 JL. RAYA GONDANG LEGI NO. 04, BEJI 655291 CV MITRA HUSADA IKS/23/052015 RS.TRAUMA CENTRE

25/05/2015 31/12/2015

25 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

26 1500000001043 KLINIK MITRA 95 JL. STADION 28 PANDAAN / JL. PATTIMURA 636028 CV MITRA HUSADA IKS/23/05/2015RS.TRAUMA CENTRE 25/05/2015 31/12/2015

27 1500000001052KLINIK RAWAT INAP ISLAM AISYIYAH

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

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

28 1500000001052KLINIK RAWAT INAP ISLAM AISYIYAH

JL. PAHLAWAN SUNARYO 257, KUTOREJO, PANDAAN

637367 IKS/24/052015RS.TRAUMA CENTRE

25/05/2015 31/12/2015

29 1500000000768 RS BHAYANGKARA PUSDIK BRIMOB WATUKOSEK

JL. RAYA WATUKOSEK, GEMPOL 336050343 BRIMOB PER/22/042015 RS.TRAUMA CENTRE

28/04/2015 28/04/2017


Periode : 01/01/2015 s/d 31/10/2016


348 / 44607-11-201606:23:31



IKS


30 1500000001233 RS RIZANI HUSADA JL. RAYA KOTAANYAR NO. 42 773444 PT RIZANI HUSADA IKS/26/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

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

32 1400000000264 RSI MASYITHOH JL. A. YANI NO. 6-7, BANGIL 741018 YAYASAN PER/27/082015 RS.TRAUMA CENTRE

01/08/2015 31/12/2015

33 1400000000264 RSI MASYITHOH JL. A. YANI NO. 6-7, BANGIL 741018 YAYASAN IKS/01/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

34 1400000000605 RSUD BANGIL JL. RAYA RACI BANGIL 744900 DR. AGUNG BASUKI IKS/29/122015 RS.TRAUMA CENTRE 21/12/2015 31/12/2016

35 1400000000432 RSUD DR MOHAMAD SALEH JL MAYJEND PANJAITAN 65 433119DR BAMBANG AGUS SUWIGNYA IKS/28/112015

RS.TRAUMA CENTRE 21/12/2015 31/12/2016

36 1500000000514 RSUD DR. R. SOEDARSONO JL . DR. WAHIDIN SUDIRO HUSODO NO. 1-4 421073 DR. SUDARMANTO PER/19/042015 RS.TRAUMA CENTRE

01/04/2015 31/12/2015

37 1500000000087 RSUD TONGAS JL RAYA TONGAS 229 511836 DRG KAMALIYAH TJIPLUK P.L, MMKES


13/01/2015 31/12/2015

38 1500000000087 RSUD TONGAS JL RAYA TONGAS 229 511836DRG KAMALIYAH TJIPLUK P.L, MMKES IKS/02/012016

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

39 1400000000604 RSUD WALUYO JATI JL. DR SOETOMO NO 1 KRAKSAAN 846877DR ANANG BUDI Y.M.MKES IKS/30/122015

RS.TRAUMA CENTRE 21/12/2015 31/12/2016

KANTOR CABANG : N05- KANTOR CABANG MOJOKERTO


Periode : 01/01/2015 s/d 31/10/2016


349 / 44607-11-201606:23:31



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

2 1500000001601 BP JAMSOSTEK 106 JL RAYA WONOSARI NO 112 NGORO 61385 6817998 IR H TEUKU ISMAIL PER/18/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

3 1500000000346 KLINIK ASY-SYIFA JL RAYA PLOSO DS REJOAGUNG KEC PLOSO

61453 885995 DR ELDYANTO YUYUN PER/09/032015 RS.TRAUMA CENTRE

01/03/2015 31/12/2015

4 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

5 1500000001603 KLINIK CITA MULIA PERUM WIKARSA BLOK G NO1 KENANTEN PURI 61311 323302 CV GALUH MERALDA PER/20/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

6 1500000001603 KLINIK CITA MULIAPERUM WIKARSA BLOK G NO1 KENANTEN PURI 61311 323302 CV GALUH MERALDA PER56/122015

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

7 1500000001606 KLINIK EMMA JL JETIS TAMA NO 3 GRIYA JETIS PERMAI 61352 CV BANGUN SESAMA DAMAI SEJAHTERA


01/06/2015 31/12/2015

8 1500000001606 KLINIK EMMA JL JETIS TAMA NO 3 GRIYA JETIS PERMAI 61352 CV BANGUN SESAMA DAMAI SEJAHTERA


01/01/2016 31/12/2016

9 7-4872489653 KLINIK GALENAJL RAYA JATI KULON LENGKONG MOJOANYAR 61364

CV BANGUN SESAMA DAMAI SEJAHTERA PER/12/092016

RS.TRAUMA CENTRE 28/10/2016 31/12/2017

10 1400000000107 KLINIK INDUSTRI MEDIKARUKO NGORO INDUSTRI PERSADA KAV A4-A6 61385 6817979

MARIA MEILITASARI HARLIN DR, SPPD, MARS PER/54/122015

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

11 1400000000107 KLINIK INDUSTRI MEDIKARUKO NGORO INDUSTRI PERSADA KAV A4-A6

61385 6817979MARIA MEILITASARI HARLIN DR, SPPD, MARS


01/01/2015 31/12/2015

12 1500000001597 KLINIK KELUARGA BAHAGIA

JL RAYA BADUNG DSN BADUNG DS KEDUNGLENGKONG

61371 513355 NOVEL MOHAMMAD RAMZY PUTRA


01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


350 / 44607-11-201606:23:31



IKS


13 1500000001597 KLINIK KELUARGA BAHAGIA

JL RAYA BADUNG DSN BADUNG DS KEDUNGLENGKONG 61371 513355 NOVEL MOHAMMAD

RAMZY PUTRA PER/12/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

14 1500000001604 KLINIK MITRA 14 PERAK DSN GADING DS GADINGMANGU KEC PERAK 61461 DR WARTIK PER/51/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

15 1500000001604 KLINIK MITRA 14 PERAK DSN GADING DS GADINGMANGU KEC PERAK

61461 DR WARTIK PER/21/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

16 1500000001607 KLINIK MITRA 39 JL RAYA DIWEK NO 39 KEC DIWEK 61471 DR BETTY ENDAH WARNI MKES


01/06/2015 31/12/2015

17 1500000001607 KLINIK MITRA 39 JL RAYA DIWEK NO 39 KEC DIWEK 61471 DR BETTY ENDAH WARNI MKES PER/53/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

18 1500000001582 KLINIK POLRES JOMBANG JL. KH. WAHID HASYIM NO 117 861843 PER/31/062015RS.TRAUMA CENTRE 01/06/2015 31/05/2017

19 1500000001588 KLINIK POLRES KOTA MOJOKERTO

JL. BHAYANGKARA PER/30/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2017

20 1500000001589 KLINIK POLRES MOJOKERTO

JL. BAYANGKARA NO. 25 PER/29/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2017

21 1500000001598 KLINIK PRATAMA MITRA 12 JL ANGGREK NO 24 CANDIMULYO 61411 878318 DR MERIDIAN GEODESI PER/47/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

22 1500000001598 KLINIK PRATAMA MITRA 12 JL ANGGREK NO 24 CANDIMULYO 61411 878318 DR MERIDIAN GEODESI PER/15/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

23 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

24 1500000001605 KLINIK PRATAMA MITRA 26 JL PANGLIMA SUDIRMAN NO 26 KEC PLOSO 61453 DR WIWIET SARASWATI PER/22/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


351 / 44607-11-201606:23:31



IKS


25 1500000001599 KLINIK PRATAMA MITRA 38 JL RAYA TROWULAN NO132 KEC TROWULAN 61362 492876 CV MITRA HUSADA PER/49/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

26 1500000001599 KLINIK PRATAMA MITRA 38 JL RAYA TROWULAN NO132 KEC TROWULAN 61362 492876 CV MITRA HUSADA PER/16/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

27 1500000001600 KLINIK PRATAMA MITRA 47 JL RAYA JETIS NO 14 61352 363786 IR H TEUKU ISMAIL PER/17/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

28 1500000001600 KLINIK PRATAMA MITRA 47 JL RAYA JETIS NO 14 61352 363786 IR H TEUKU ISMAIL PER/50/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

29 1500000001595 KLINIK PRATAMA SURYA HUSADA 2

JL RAYA PRAMBON DS NGIMBANG MOJOSARI 61384 SITI NUR HIDAYATI ST


30 1500000001595KLINIK PRATAMA SURYA HUSADA 2

JL RAYA PRAMBON DS NGIMBANG MOJOSARI 61384

SITI NUR HIDAYATI ST MKES PER/28/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

31 7-4666449663 KLINIK PRIMA MEDIKA JALAN MASJID NO 41 61382 0321590809

ACHMAD PRIMAHARIANTO


28/10/2016 31/12/2017

32 1500000001602 KLINIK RAWAT INAP IKFINA JL RAYA PACING NO 27 KEC BANGSAL 397355 YAYASAN PERMATA MOJOKERTO


01/06/2015 31/12/2015

33 1500000001581 KLINIK SPN MOJOKERTO PULONITI, BANGSAL PER/32/062015RS.TRAUMA CENTRE 01/06/2015 31/05/2017

34 1500000001596 KLINIK SURYA HUSADA RAYA TRAWAS DSN WRINGINANOM DS MOJOREJO 61384

SITI NUR HIDAYATI ST MKES PER/27/062015

RS.TRAUMA CENTRE 01/06/2015 30/06/2015

35 1500000001596 KLINIK SURYA HUSADA RAYA TRAWAS DSN WRINGINANOM DS MOJOREJO

61384SITI NUR HIDAYATI ST MKES


01/01/2016 31/12/2016

36 1500000001584 PUSKESMAS BLOOTO JL RAYA CINDE NO 3 PRAJURITKULON 331234 PER/36/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


352 / 44607-11-201606:23:31



IKS


37 1500000001586 PUSKESMAS GEDONGAN JL GAJAHMADA NO 54 323252 PER/34/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

38 1500000001587 PUSKESMAS KEDUNDUNG JL BY PASS KEDUNDUNG 392028 PER/33/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

39 1500000001585 PUSKESMAS MENTIKAN JL PRAPANCA NO 55 PRAJURITKULON 321057 PER/35/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

40 1500000001583 PUSKESMAS WATES JL LAWU RAYA NO 1 WATES 330144 PER/37/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

41 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

42 1500000001608 RS AL AZIZ JL RAYA TEMBELANG KEC TEMBELANG 61453 853757 YAYASAN AL AZIZ PER/25/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

43 1400000000481 RS DHARMA HUSADA JL RAYA NGORO 192 61385 6817833 HJ YUNI SETIJO SOEKORINI


22/12/2015 31/12/2016

44 1400000000463 RS DR MOEDJITO DWIDJOSISWOJO

JL. HAYAM WURUK NO 9 61411 864308 PT MOEDJITO DWIDJOSISWOJO


22/12/2015 31/12/2016

45 0900000000027 RS EMMA (RS TC) JL RAYA IJEN NO 67 613110321328737

DR MAGDALENA SITORUS PER/05/012014

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

46 0900000000027 RS EMMA (RS TC) JL RAYA IJEN NO 67 613110321328737

DR MAGDALENA SITORUS PER/64/122015

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

47 1500000000353 RS GATOELJL RADEN WIJAYA NO 56 KRANGGAN, PRAJURIT KULON

61319 328557PT NUSANTARA MEDIKA UTAMA


01/01/2016 31/12/2016

48 1500000000353 RS GATOEL JL RADEN WIJAYA NO 56 KRANGGAN, PRAJURIT KULON

61319 328557 PT NUSANTARA MEDIKA UTAMA


01/03/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


353 / 44607-11-201606:23:31



IKS


49 1500000000927 RS KAMAR MEDIKA JL EMPUNALA NO 351 KEDUNDUNG MAGERSARI 330066 PT WAK KAMAR MEDIKA

HOSPITAL PER/11/052015 RS.TRAUMA CENTRE 01/05/2015 31/12/2015

50 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

51 1400000000510 RS MAWADDAH MEDIKA JL RAYA NGIJINGAN NGORO 61384 596666 PT WILUJENG ABADI SEJAHTERA


22/12/2015 31/12/2016

52 1500000000925 RS MUTIARA HATI JL RAYA KEMANTREN WETAN NO 49 TERUSAN GEDEG

61351 363442 SULFAKAR DR SPOG PER/66/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

53 1500000000925 RS MUTIARA HATI JL RAYA KEMANTREN WETAN NO 49 TERUSAN GEDEG 61351 363442 SULFAKAR DR SPOG PER/10/052015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

54 1500000001594RS NAHDLATUL ULAMA JOMBANG JL KH HASYIM ASYARI NO 211 878700

PT RUMAH SAKIT NAHDLATUL ULAMA JOMBANG


55 1500000001594 RS NAHDLATUL ULAMA JOMBANG

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


20/01/2016 31/12/2016

56 1500000001522 RS PELENGKAP MEDICAL CENTER

JL IR JUANDA NO 03 61411 877945 PT PELANGKAP MEDICA SEJAHTERA


01/01/2016 31/12/2016

57 1500000001522RS PELENGKAP MEDICAL CENTER JL IR JUANDA NO 03 61411 877945

PT PELANGKAP MEDICA SEJAHTERA PER/14/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

58 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

59 0800000000011 RS SIDO WARAS (RS TC)JL RAYA PASAR SAWAHAN KM 10 BANGSAL

61381 598621DR MARIA M HARLIM SP.PD


01/01/2015 31/12/2015

60 0800000000034 RSI AROFAH (RS TC) JL. GAJAH MADA NO.1 MOJOSARI 61382 596900 DR HR SETIOHARTONO PER/03/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


354 / 44607-11-201606:23:31



IKS


61 0800000000034 RSI AROFAH (RS TC) JL. GAJAH MADA NO.1 MOJOSARI 61382 596900 DR HR SETIOHARTONO PER/62/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

62 1500000001523 RSI HASANAH JL HOS COKROAMINOTO NO 26-28 MOJOKERTO 321635

PIMPINAN WILAYAH MUHAMMADIYAH JAWA TIMUR


63 1500000001523 RSI HASANAH JL HOS COKROAMINOTO NO 26-28 MOJOKERTO

321635PIMPINAN WILAYAH MUHAMMADIYAH JAWA TIMUR


01/06/2015 31/12/2015

64 1500000001621 RSI JOMBANG JL BRIGJEN KRETARTO NO 22 A 61411 860074

YAYASAN AMAL SHOLEH IKATAN PERSAUDARAAN HAJI INDONESIA


01/06/2015 31/12/2015

65 1500000001621 RSI JOMBANG JL BRIGJEN KRETARTO NO 22 A 61411 860074

YAYASAN AMAL SHOLEH IKATAN PERSAUDARAAN HAJI INDONESIA


66 0800000000033 RSI SAKINAH (RS TC) JL R A BASUNI NO 12 61361 321922 DR SULAIMAN ROSYID PER/61/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

67 0800000000033 RSI SAKINAH (RS TC) JL R A BASUNI NO 12 61361 321922 DR SULAIMAN ROSYID PER/04/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

68 1500000001623 RSU KARTINI JL AIRLANGGA NO 37 MOJOSARI 61382 592261 YAYASAN KARTINI PER/02/012016 RS.TRAUMA CENTRE

07/06/2016 31/12/2016

69 1500000001623 RSU KARTINI JL AIRLANGGA NO 37 MOJOSARI 61382 592261 YAYASAN KARTINI PER/39/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

70 7-4265992960 RSUD RADEN ACHMAD BASOENI

JL RAYA GEDEG NO 17 KEC GEDEG KAB MOJOKERTO 61351 032136475

2RUMAH SAKIT PEMERINTAH PER/007/062016 RS.TRAUMA

CENTRE 12/08/2016 31/12/2018

71 0800000000010RSUD. PROF. DR. SOEKANDAR (RS TC)

JL HAYAM WURUK NO 25 MOJOSARI 61382 591591 PER/02/012015RS.TRAUMA CENTRE

01/01/2015 31/12/2015

72 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


Periode : 01/01/2015 s/d 31/10/2016


355 / 44607-11-201606:23:31



IKS


73 1500000000347 RUMAH SAKIT KRISTEN MOJOWARNO JL MERDEKA NO 59 MOJOWARNO 61475 495093 YAYASAN KESEHATAN

GKJW PER/57/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

74 1500000000347 RUMAH SAKIT KRISTEN MOJOWARNO JL MERDEKA NO 59 MOJOWARNO 61475 495093 YAYASAN KESEHATAN

GKJW PER/08/032015 RS.TRAUMA CENTRE 01/03/2015 31/12/2015

75 7-4522086983 UPT RUMAH SAKIT KUSTA SUMBERGLAGAH

DSN SUMBERGLAGAH DS TANJUNGKENONGO KEC PACET KAB MOJOKERTO

61374 0321690441

UPT RUMAH SAKIT KUSTA SUMBERGLAGAH


28/10/2016 31/12/2017

KANTOR CABANG : N06- KANTOR CABANG BANYUWANGI


IKS


1 1500000001578 BALAI PENGOBATAN POLRES BANYUWANGI

JL. LETKOL ISTIQLAH NO. 53 421060 PER/06/062015 RS.TRAUMA CENTRE

22/06/2015 31/12/2015

2 1500000001577 BALAI PENGOBATAN POLRES SITUBONDO

JALAN PB. SUDIRMAN NO. 30, KEC. SITUBONDO


22/06/2015 31/12/2015

3 1500000000827 KLINIK BRAWIJAYA JL BRAWIJAYA NO 46 KEBALENAN 423711 DR EDI HERMANTO PER/07/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

4 1500000000827 KLINIK BRAWIJAYA JL BRAWIJAYA NO 46 KEBALENAN 423711 DR EDI HERMANTO PER/06/052015RS.TRAUMA CENTRE 01/05/2015 31/12/2015

5 1500000000832KLINIK KHADIJAH PKU MUHAMMADIYAH MUNCAR

JL BRAWIJAYA 23A MUNCAR 592890PIMPINAN CABANG MUHAMMADIYAH MUNCAR


01/01/2016 31/12/2016

6 1500000000832 KLINIK KHADIJAH PKU MUHAMMADIYAH MUNCAR

JL BRAWIJAYA 23A MUNCAR 592890PIMPINAN CABANG MUHAMMADIYAH MUNCAR


01/05/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


356 / 44607-11-201606:23:31



IKS


7 1400000000367 RS AL HUDA JL RAYA GAMBIRAN 225 GENTENG 842033 YYS NURUL HUDA PER/16/102015 RS.TRAUMA CENTRE 28/12/2015 31/12/2016

8 7-1989906563 RS NAHDLATUL ULAMA BANYUWANGI JL RAYA MANGIR NO 09 KEC ROGOJAMPI 68462 632965000

PC NAHDLATUL ULAMA KABUPATEN BANYUWANGI


9 1200000000005 RS YASMIN JL LETKOL ISTIQLAH 80-84 421198 YAYASAN SUMBER WARAS


01/01/2016 31/12/2016

10 1200000000005 RS YASMIN JL LETKOL ISTIQLAH 80-84 421198 YAYASAN SUMBER WARAS


01/01/2015 31/12/2015

11 1400000000010 RSU BHAKTI HUSADA KRIKILAN KRIKILAN GLENMORE 821118 PT ROLAS NUSANTARA


12 1400000000010RSU BHAKTI HUSADA KRIKILAN KRIKILAN GLENMORE 821118

PT ROLAS NUSANTARA MEDIKA PER/19/122014

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

13 7-4419954833 RSU PKU MUHAMMADIYAH ROGOJAMPI

JL DIPONEGORO NO 20 68462 0333 631149

PIMPINAN CABANG MUHAMMADIYAH ROGOJAMPI BANYUWANGI


19/08/2016 31/12/2017

14 1500000001552 RSUD ASEMBAGUS SITUBONDO

JL RAYA ASEMBAGUS KECAMATAN ASEMBAGUS


22/06/2015 31/12/2015

15 1500000001552RSUD ASEMBAGUS SITUBONDO

JL RAYA ASEMBAGUS KECAMATAN ASEMBAGUS 452193 PER/06/012016

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

16 1500000001392 RSUD BESUKI JL OLAHRAGA NO 55 BESUKI 891118 PER/08/052015 RS.TRAUMA CENTRE 01/05/2015 31/12/2015

17 1500000001392 RSUD BESUKI JL OLAHRAGA NO 55 BESUKI 891118 PER/05/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

18 1400000000672 RSUD BLAMBANGAN BANYUWANGI

JL LETKOL ISTIQLAH BANYUWANGI 421118 PEMDA BANYUWANGI PER/20/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


357 / 44607-11-201606:23:31



IKS


19 1400000000672 RSUD BLAMBANGAN BANYUWANGI JL LETKOL ISTIQLAH BANYUWANGI 421118 PEMDA BANYUWANGI PER/03/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

20 1400000000470 RSUD DR ABDOER RAHEM JL ANGGREK 68 671028 PEMDA SITUBONDO PER/17/122015 RS.TRAUMA CENTRE 28/12/2015 31/12/2016

21 1500000000826 RSUD GENTENG BANYUWANGI

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

01/01/2016 31/12/2016

22 1500000000826 RSUD GENTENG BANYUWANGI

JL HASANUDDIN NO 98 GENTENG 845839 PER/05/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

KANTOR CABANG : N07- KANTOR CABANG MADIUN


IKS


1 1500000001665 BIDDOKKES POLRES MADIUN

JL. SOEKARNO-HATTA NO.66 459725 PER/068/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

2 1500000001670BIDDOKKES POLRESTA MADIUN JL SUMETERA NO 28 465455 PER/069/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

3 1500000000857 KLINIK BP BHAKTI RAHAYU JL THAMRIN NO 99 MADIUN 462439CV BHAKTI NADINA CORPORATE PER/32/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

4 1500000000786 PUSKESMAS BALEREJOJL RAYA MADIUN SURABAYA NO 82 DS BALEREJO KEC BALEREJO


01/05/2015 30/04/2016

5 1500000000786 PUSKESMAS BALEREJO JL RAYA MADIUN SURABAYA NO 82 DS BALEREJO KEC BALEREJO


30/06/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


358 / 44607-11-201606:23:31



IKS


6 1500000000774 PUSKESMAS BANGUNSARI JL PANJANG PUNJUNG DS DOLOPO KEC.DOLOPO 368601 PER/16/052016 RS.TRAUMA

CENTRE 09/08/2016 31/12/2017

7 1500000000774 PUSKESMAS BANGUNSARI JL PANJANG PUNJUNG DS DOLOPO KEC.DOLOPO 368601 PER/34/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

8 1500000000938 PUSKESMAS BANJAREJO JL. BAYANGKARA NO.1 KEL BANJAREJO KEC. TAMAN


13/05/2016 31/12/2017

9 1500000000938 PUSKESMAS BANJAREJO JL. BAYANGKARA NO.1 KEL BANJAREJO KEC. TAMAN


01/05/2015 30/04/2016

10 1500000000780 PUSKESMAS DAGANGAN JL RAYA DAGANGAN PAGOTAN NO 57 DS DAGANGAN KEC DAGANGAN 367079 PER/40/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

11 1500000000780 PUSKESMAS DAGANGANJL RAYA DAGANGAN PAGOTAN NO 57 DS DAGANGAN KEC DAGANGAN 367079 PER/16/052016

RS.TRAUMA CENTRE 12/07/2016 31/12/2017

12 1500000000939 PUSKESMAS DEMANGAN JL. SOEKARNO HATTA NO. 47 KEL. DEMANGAN KEC. TAMAN


01/05/2015 30/04/2016

13 1500000000939 PUSKESMAS DEMANGAN JL. SOEKARNO HATTA NO. 47 KEL. DEMANGAN KEC. TAMAN


13/05/2016 31/12/2017

14 1500000000784 PUSKESMAS DIMONGJL RAYA DIMONG DS DIMONG KEC MADIUN 458123 PER/16/052016

RS.TRAUMA CENTRE 12/07/2016 31/12/2017

15 1500000000784 PUSKESMAS DIMONGJL RAYA DIMONG DS DIMONG KEC MADIUN 458123 PER/44/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

16 1500000000777 PUSKESMAS GANTRUNGJL RAYA DOLOPO DS SIDOREJO KEC.KEBONSARI


01/05/2015 30/04/2016

17 1500000000777 PUSKESMAS GANTRUNG JL RAYA DOLOPO DS SIDOREJO KEC.KEBONSARI


12/07/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


359 / 44607-11-201606:23:31



IKS


18 1500000000778 PUSKESMAS GEGER JL RAYA PONOROGO NO 48 DS PURWOREJOKEC GEGER 367158 PER/16/052016 RS.TRAUMA

CENTRE 12/07/2016 31/12/2017

19 1500000000778 PUSKESMAS GEGER JL RAYA PONOROGO NO 48 DS PURWOREJOKEC GEGER 367158 PER/38/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

20 1500000000794 PUSKESMAS GEMARANG JL TGP NO 17 DS GEMARANG KEC GEMARANG


01/05/2015 30/04/2016

21 1500000000794 PUSKESMAS GEMARANG JL TGP NO 17 DS GEMARANG KEC GEMARANG


12/07/2016 31/12/2017

22 1500000000781 PUSKESMAS JETIS JL JETIS DS JETIS KEC DAGANGAN 367664 PER/41/052015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

23 1500000000781 PUSKESMAS JETIS JL JETIS DS JETIS KEC DAGANGAN 367664 PER/16/052016RS.TRAUMA CENTRE 12/07/2016 31/12/2017

24 1500000000782 PUSKESMAS JIWAN JL RAYA SOLO NO 85 DS JIWAN KEC.JIWAN 465023 PER/42/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

25 1500000000782 PUSKESMAS JIWAN JL RAYA SOLO NO 85 DS JIWAN KEC.JIWAN 465023 PER/16/052016 RS.TRAUMA CENTRE

12/07/2016 31/12/2017

26 1500000000779 PUSKESMAS KAIBONJL PANCOTARUNO NO 407 DS KAIBON KEC GEGER 455636 PER/39/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

27 1500000000779 PUSKESMAS KAIBONJL PANCOTARUNO NO 407 DS KAIBON KEC GEGER 455636 PER/16/052016

RS.TRAUMA CENTRE 12/07/2016 31/12/2017

28 1500000000795 PUSKESMAS KARE JL RAYA RANDU ALAS KARE KEC KARE 3406616 PER/16/052016RS.TRAUMA CENTRE

12/07/2016 31/12/2017

29 1500000000795 PUSKESMAS KARE JL RAYA RANDU ALAS KARE KEC KARE 3406616 PER/55/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


360 / 44607-11-201606:23:31



IKS


30 1500000000776 PUSKESMAS KEBONSARI JL UTERAN KEBONSARI NO 13 DS SINGGAHAN KEC KEBONSARI 367991 PER/16/052016 RS.TRAUMA

CENTRE 12/07/2016 31/12/2017

31 1500000000776 PUSKESMAS KEBONSARI JL UTERAN KEBONSARI NO 13 DS SINGGAHAN KEC KEBONSARI 367991 PER/36/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

32 1500000000799 PUSKESMAS KLAGENSERUT JL RAYA KLAGEN SERUT KEC JIWAN 499761 PER/59/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

33 1500000000799 PUSKESMAS KLAGENSERUT JL RAYA KLAGEN SERUT KEC JIWAN 499761 PER/16/052016 RS.TRAUMA CENTRE

12/07/2016 31/12/2017

34 1500000000798 PUSKESMAS KLECOREJO JL RAYA WATES DS KLECOREJO KEC MEJAYAN 388155 PER/58/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

35 1500000000798 PUSKESMAS KLECOREJOJL RAYA WATES DS KLECOREJO KEC MEJAYAN 388155 PER/16/052016

RS.TRAUMA CENTRE 12/07/2016 31/12/2017

36 1500000000791 PUSKESMAS KREBET JL GAWANG UTARA DS KREBET KEC.PILANGKENCENG


01/05/2015 30/04/2016

37 1500000000791 PUSKESMAS KREBET JL GAWANG UTARA DS KREBET KEC.PILANGKENCENG


12/07/2016 31/12/2017

38 1500000000783 PUSKESMAS MADIUNJL RAYA PUSKESMAS NO 9 DS TIRON KEC MADIUN 458271 PER/43/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

39 1500000000783 PUSKESMAS MADIUNJL RAYA PUSKESMAS NO 9 DS TIRON KEC MADIUN 458271 PER/16/052016

RS.TRAUMA CENTRE 12/07/2016 31/12/2017

40 1500000000936 PUSKESMAS MANGUHARJOJL. GAJAHMADA NO. 124 KEL. MANGUHARJO KEC. MANGUHARJO


01/05/2015 30/04/2016

41 1500000000936 PUSKESMAS MANGUHARJO JL. GAJAHMADA NO. 124 KEL. MANGUHARJO KEC. MANGUHARJO


13/05/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


361 / 44607-11-201606:23:31



IKS


42 1500000000789 PUSKESMAS MEJAYAN JL PANGLIMA SUDIRMAN NO 52 DS MEJAYAN KEC.MEJAYAN 384543 PER/16/052016 RS.TRAUMA

CENTRE 12/07/2016 31/12/2017

43 1500000000789 PUSKESMAS MEJAYAN JL PANGLIMA SUDIRMAN NO 52 DS MEJAYAN KEC.MEJAYAN 384543 PER/49/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

44 1500000000775 PUSKESMAS MLILIR JL RAYA MADIUN PONOROGO NO 06 MLILIR KEC DLOPO


13/05/2016 31/12/2017

45 1500000000775 PUSKESMAS MLILIR JL RAYA MADIUN PONOROGO NO 06 MLILIR KEC DLOPO


01/05/2015 30/04/2016

46 1500000000797 PUSKESMAS MOJOPURNO JL RAYA DUNGUS DS MOJOPURNO KEC WUNGU PER/16/052016 RS.TRAUMA

CENTRE 13/05/2016 31/12/2017

47 1500000000797 PUSKESMAS MOJOPURNOJL RAYA DUNGUS DS MOJOPURNO KEC WUNGU PER/57/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

48 1500000000934 PUSKESMAS ORO - ORO OMBO

JL. DIPONEGORO NO. 22 KEL. ORO-ORO OMBO KEC KARTOHARJO


01/05/2015 30/04/2016

49 1500000000934 PUSKESMAS ORO - ORO OMBO

JL. DIPONEGORO NO. 22 KEL. ORO-ORO OMBO KEC KARTOHARJO


13/05/2016 31/12/2017

50 1500000000937 PUSKESMAS PATIHANJL. MENDUT NO.1 KEL. PATIHAN KEC. MANGUHARJO 462272 PER/17/052016

RS.TRAUMA CENTRE 13/05/2016 31/12/2017

51 1500000000937 PUSKESMAS PATIHANJL. MENDUT NO.1 KEL. PATIHAN KEC. MANGUHARJO 462272 PER/65/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

52 1500000000790PUSKESMAS PILANG KENCENG

JL RAYA KENONGO REJO NO 774B DS KENONGOREJO KEC PILANGKENCENG

383536 PER/16/05/2016RS.TRAUMA CENTRE

13/05/2016 31/12/2017

53 1500000000790 PUSKESMAS PILANG KENCENG

JL RAYA KENONGO REJO NO 774B DS KENONGOREJO KEC PILANGKENCENG


01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


362 / 44607-11-201606:23:31



IKS


54 1500000000792 PUSKESMAS SARADAN JL RAYA SARADAN DS SUGIHWARAS KEC SARADAN PER/16/052016 RS.TRAUMA

CENTRE 13/05/2016 31/12/2017

55 1500000000792 PUSKESMAS SARADAN JL RAYA SARADAN DS SUGIHWARAS KEC SARADAN PER/52/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

56 1500000000785 PUSKESMAS SAWAHAN JL RAYA KAJANG DS KAJANG KEC SAWAHAN


13/05/2016 31/12/2017

57 1500000000785 PUSKESMAS SAWAHAN JL RAYA KAJANG DS KAJANG KEC SAWAHAN


01/05/2015 30/04/2016

58 1500000000787 PUSKESMAS SIMO JL RAYA BALEREJO-MUNENG NO 96 DS SIMO KEC BALEREJO 661631 PER/47/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

59 1500000000787 PUSKESMAS SIMOJL RAYA BALEREJO-MUNENG NO 96 DS SIMO KEC BALEREJO 661631 PER/16/05/2016

RS.TRAUMA CENTRE 13/05/2016 31/12/2017

60 1500000000793 PUSKESMAS SUMBERSARI JL RAYA TULUNG NO 05 DS SUMBERSARI KEC SARADAN


13/05/2016 31/12/2017

61 1500000000793 PUSKESMAS SUMBERSARI JL RAYA TULUNG NO 05 DS SUMBERSARI KEC SARADAN


01/05/2015 30/04/2016

62 1500000000935 PUSKESMAS TAWANGREJOJL. TAWANGSARI NO. 39 KEL. TAWANGREJO KEC. KARTOHARJO 483997 PER/17/052016

RS.TRAUMA CENTRE 13/05/2016 31/12/2017

63 1500000000935 PUSKESMAS TAWANGREJOJL. TAWANGSARI NO. 39 KEL. TAWANGREJO KEC. KARTOHARJO 483997 PER/63/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

64 1500000000788 PUSKESMAS WONOASRIRAYA WONOASRI DS WONOASRI KEC WONOASRI


01/05/2015 30/04/2016

65 1500000000788 PUSKESMAS WONOASRI RAYA WONOASRI DS WONOASRI KEC WONOASRI


13/05/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


363 / 44607-11-201606:23:31



IKS


66 1500000000796 PUSKESMAS WUNGU JL RAYA KARE NO 113 DS WUNGU KEC WUNGU 494048 PER/16/052016 RS.TRAUMA

CENTRE 13/05/2016 31/12/2017

67 1500000000796 PUSKESMAS WUNGU JL RAYA KARE NO 113 DS WUNGU KEC WUNGU 494048 PER/56/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

68 1400000000150 RSI SITI AISYAH MADIUN JL MAYJEND SUNGKONO NO 38 464822 PP MUHAMMADIYAH PER/18/052016 RS.TRAUMA CENTRE

13/05/2016 31/12/2017

69 1400000000150 RSI SITI AISYAH MADIUN JL MAYJEND SUNGKONO NO 38 464822 PP MUHAMMADIYAH PER/82/102015 RS.TRAUMA CENTRE

31/12/2015 30/04/2016

70 1400000000149 RSU DARMAYU JL. DR. SUTOMO NO. 44 481320 PT DARMAYU PURI KENCANA PER/19/052016 RS.TRAUMA

CENTRE 13/05/2016 31/12/2017

71 1400000000149 RSU DARMAYU JL. DR. SUTOMO NO. 44 481320PT DARMAYU PURI KENCANA PER/00X/042015

RS.TRAUMA CENTRE 29/12/2015 30/04/2016

72 1400000000420 RSUD DR DARSONO KABUPATEN PACITAN

JL A YANI NO 51 63511 0357881410

PEMERINTAH PER/26/072016 RS.TRAUMA CENTRE

31/08/2016 31/12/2017

73 1400000000419 RSUD DR SAYYIDIMAN MAGETAN

JL.PAHLAWAN NO.2 MAGETAN 63311 0351895023

PEMKAB MAGETAN PER/20/052016 RS.TRAUMA CENTRE

22/06/2016 31/12/2017

74 7-3349569013 RSUD KOTA MADIUN JL CAMPURSARI NO 12B 631510351481314

PEMERINTAH KOTA MADIUN PER/08/032016

RS.TRAUMA CENTRE 13/05/2016 31/12/2016

75 1500000001809RUMAH SAKIT ISLAM AT-TIN HUSADA NGAWI JL RAYA NGAWI - SOLO KM 4 WATUALUNG 63252 747888 HJ SRI YATIN SE PER/24/072016

RS.TRAUMA CENTRE 09/08/2016 31/12/2017

76 1500000001809RUMAH SAKIT ISLAM AT-TIN HUSADA NGAWI

JL RAYA NGAWI - SOLO KM 4 WATUALUNG 63252 747888 HJ SRI YATIN SE PER/69/062015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

77 1500000001246 UPT PELATIHAN KERJA CARUBAN MADIUN

JL SUMATERA NO 27 CARUBAN MADIUN 383166 PER/33/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


364 / 44607-11-201606:23:31


KANTOR CABANG : N08- KANTOR CABANG BLITAR


IKS


1 7-3033275153 KLINIK PRATAMA RAWAT INAP ABA HUSADA

JL RAYA KARANGAN KM 7 66361 0355795831

DR. MOKH ROFIQ HINDIONO,MMRS


25/04/2016 31/12/2017

2 1500000001631 POLRES BLITAR JALAN RAYA TALUN NO 88 POLRES BLITAR PER/06/062015 RS.TRAUMA CENTRE 22/06/2015 21/06/2016

3 1500000001632 POLRES KOTA BLITAR JL. P. SUDIRMAN 32 POLRES KOTA BLITAR PER/06/062015 RS.TRAUMA CENTRE 22/06/2015 21/06/2016

4 1500000001629 POLRES TRENGGALEK JL. PANGLIMA SUDIRMAN 42 POLRES TRENGGALEK PER/06/062015 RS.TRAUMA CENTRE 22/06/2015 21/06/2016

5 1500000001630 POLRES TULUNGAGUNG JL. AHMAD YANI TIMUR NO 9 POLRES TULUNGAGUNG PER/06/062015 RS.TRAUMA CENTRE

22/06/2015 21/06/2016

6 1500000001915 RS SYUHADA HAJI JL TANJUNG NO 158 66122 801607 YAYASAN MONUMEN SYUHADA HAJI PER/03/062015 RS.TRAUMA

CENTRE 25/06/2015 24/06/2017

7 1400000000148 RSU AMINAH BLITAR JL VETERAN NO.39 KOTA BLITAR 66113 816304YAY. RUMAH SAKIT AMINAH BLITAR PER/09/052016

RS.TRAUMA CENTRE 02/05/2016 31/12/2017

8 07732 RSU AN-NISAA JL.SUPARYONO NO.1 TALUN 692999 SRI MUNTAMAH PER/05/042016RS.TRAUMA CENTRE

01/04/2016 31/12/2017

9 7-4219807443 RSU ANANDA JL MASTRIP NO 14 66152 0342553472

PT ANANDA PRATAMA HUSADA


29/07/2016 31/12/2017

10 1500000000224 RSU ISLAM ORPEHA TULUNGAGUNG

JL KHR ABDUL FATAH DS. BATANGSAREN KEC. KAUMAN

323186 R. H LAITUPA ABDULMUTALIB


01/02/2015 31/01/2017

11 7-4452931573RSU MUHAMMADIYAH BANDUNG JL P. SUDIRMAN NO 42 MERGAYU 66274

0355532760

PERSYARIKATAN MUHAMMADIYAH PER/278/082016

RS.TRAUMA CENTRE 23/08/2016 31/12/2017

12 1400000000201RSUD DR SOEDOMO KAB. TRENGGALEK JL DR SOETOMO NO.02 TRENGGALEK 66312 791118 PEMKAB TRENGGALEK PER/274/062016

RS.TRAUMA CENTRE 01/06/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


365 / 44607-11-201606:23:31



IKS


13 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

14 7-1575901783 RSUD NGUDI WALUYO WLINGI JL DR SOECIPTO NO 5 66184 034269100

6 PEMKAB BLITAR PER/01/012016 RS.TRAUMA CENTRE 25/01/2016 31/12/2016

15 1500000000831RUMAH SAKIT BHAYANGKARA TULUNGAGUNG

JL I GUSTI NGURAH RAI NO.25-27 321203 DR. SUMARSONO, SP.RAD, MM


05/05/2015 04/05/2017

16 7-3548740573 RUMAH SAKIT UMUM ISLAM MADINAH

JL. JATIWAYANG LK 2 DUSUN BEJI 66292 03553491131

PT AL IKHLAS MADINAH PER/273/052016 RS.TRAUMA CENTRE

27/05/2016 31/12/2017

17 7-3917161113 RUMAH SAKIT UMUM SATITI PRIMA HUSADA

JL RAYA BALESONO NGUNUT KAB TULUNGAGUNG 66292 035559163

7 SUPRAPTI PER/276/062016 RS.TRAUMA CENTRE 23/06/2016 31/12/2017

KANTOR CABANG : N09- KANTOR CABANG MADURA


IKS


1 1500000001625FASKES POLRES BANGKALAN

JL SOEKARNO HATTA KECAMATAN BANGKALAN PER/08/062015

RS.TRAUMA CENTRE 22/06/2015 30/06/2017

2 1500000001627FASKES POLRES PAMEKASAN JL RY DESA TEJA NO. 131 PER/07/062015

RS.TRAUMA CENTRE 22/06/2015 30/06/2017

3 1500000001624 FASKES POLRES SAMPANG KARANG DALEM KECAMATAN SAMPANG PER/09/062015RS.TRAUMA CENTRE

22/06/2015 30/06/2017

4 1500000001626 FASKES POLRES SUMENEP JL URIP SUMOHARJO 35 PER/10/062015 RS.TRAUMA CENTRE

22/06/2015 30/06/2017


Periode : 01/01/2015 s/d 31/10/2016


366 / 44607-11-201606:23:31



IKS


5 1500000001553 KLINIK PRATAMA AN NUR JL RY PALDUDING KM 10 DS PLAKPAK KEC PEGANTENAN DR H ACHMAD FURQON PER/06/062015 RS.TRAUMA

CENTRE 24/06/2015 30/06/2016

6 1400000000233 PUSKESMAS TLANAKAN JL RAYA TLANAKAN PAMEKASAN 325568 PUSKESMAS PER/01/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

7 1400000000233 PUSKESMAS TLANAKAN JL RAYA TLANAKAN PAMEKASAN 325568 PUSKESMAS PER/01/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

8 1400000000437 RS LUKAS BANGKALAN JL KH MOCH KHOLIL 36A BANGKALAN 3095148 PHILIP PER/04/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

9 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

10 1500000000633RSUD DR H SLAMET MARTODIRJO PAMEKASAN 326242 PER/03/042015

RS.TRAUMA CENTRE 27/04/2015 30/04/2016

11 1500000000633 RSUD DR H SLAMET MARTODIRJO PAMEKASAN


27/07/2016 31/12/2017

12 1500000000235 RSUD SAMPANG JL RAJAWALI NO 10 323956 PER/02/022016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

13 1500000000235 RSUD SAMPANG JL RAJAWALI NO 10 323956 PER/02/022015RS.TRAUMA CENTRE 25/02/2015 31/12/2015

14 1400000000520RSUD 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


Periode : 01/01/2015 s/d 31/10/2016


367 / 44607-11-201606:23:31



IKS


1 1500000000753 BP MITRA 30 JL. BOJONEGORO NO 51 BANARAN BABAT 451058 IR T ISMAIL PER/06/052016 RS.TRAUMA CENTRE 03/06/2016 31/12/2017

2 1500000000753 BP MITRA 30 JL. BOJONEGORO NO 51 BANARAN BABAT 451058 IR T ISMAIL PER/08/052015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

3 1500000000800 BP MITRA 5 JL DR CIPTO NO 129 892665 IR T ISMAIL PER/07/052016 RS.TRAUMA CENTRE

03/06/2016 02/12/2017

4 1500000000800 BP MITRA 5 JL DR CIPTO NO 129 892665 IR T ISMAIL PER/07/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

5 1500000000752 BP MITRA 6 JL WR SUPRATMAN NO 35 321394 IR T ISMAIL PER/08/052016 RS.TRAUMA CENTRE 03/06/2016 31/12/2017

6 1500000000752 BP MITRA 6 JL WR SUPRATMAN NO 35 321394 IR T ISMAIL PER/10/052015RS.TRAUMA CENTRE 01/05/2015 30/04/2016

7 1500000000751 BP MITRA 8 JL ANDANWANGI NO 43 7722188 IR T ISMAIL PER/09/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

8 1500000000751 BP MITRA 8 JL ANDANWANGI NO 43 7722188 IR T ISMAIL PER/09/062016 RS.TRAUMA CENTRE

03/06/2016 31/12/2017

9 1500000001638DOKKES POLRES BOJONEGORO

JL MH THAMRIN NO. 46 BOJONEGORO JAWA TIMUR PER/18/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

10 1500000001636DOKKES POLRES LAMONGAN JL. KBP DURYAT LAMONGAN PER/17/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

11 1500000001633 DOKKES POLRES TUBAN JL DR WAHIDIN SH TUBAN JAWA TIMUR PER/16/062015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

12 1400000000538 RS BHAYANGKARA WAHYU TUTUKO BOJONEGORO

JL PANGLIMA SUDIRMAN NO 168-169 888786 KOMPOL. DR. BAYU DHARMA SHANTI SP.PD


21/12/2015 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


368 / 44607-11-201606:23:31



IKS


13 1300000000045 RS DR. SUYUDI PACIRAN LAMONGAN

JL RAYA DEANDELES KECAMATAN PACIRAN 661412 DR DENNY AVIANTO SPD PER/02/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

14 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

15 1300000000047 RS NAHDLATUL ULAMA (NU) TUBAN

JL LETDA SUCIPTO NO 211 328244 DR DIDIK SUHARSOYO MM MARS


01/01/2016 31/12/2016

16 1300000000047 RS NAHDLATUL ULAMA (NU) TUBAN

JL LETDA SUCIPTO NO 211 328244 DR DIDIK SUHARSOYO MM MARS


01/01/2015 31/12/2015

17 7-4404578195RSUD DR R SOSODORO DJATIKOESOMO BOJONEGORO

JL DR WAHIDIN NO 40 62111 0353881193 DR H HARIYONO PER/04/052016 RS.TRAUMA

CENTRE 19/08/2016 31/12/2017

18 7-2471813999 RSUD NGIMBANGJL. RAYA BABAT - JOMBANG NO. 227, SENDANGREJO, NGIMBANG LAMONGAN 62273 DR. TAUFIK HIDAYAT PER/1/012013

RS.TRAUMA CENTRE 11/03/2016 31/12/2016

19 1500000000747 RSUD. DR. KOESMA TUBAN JL WAHIDIN SUDIRO HUSODO NO 800 321010 DR. H ZAINUL ARIFIN, SPPK


01/05/2015 30/04/2016

20 1500000000747 RSUD. DR. KOESMA TUBAN JL WAHIDIN SUDIRO HUSODO NO 800 321010 DR. H ZAINUL ARIFIN, SPPK


01/05/2016 31/12/2017

21 1500000000517RSUD.DR.SOEGIRI. LAMONGAN JL. KUSUMA BANGSA NO.7 321718

DR. YULIARTO DWI MARTONO, MMKES

PER/4/042015-445/352/413.209/2015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

22 1500000000517RSUD.DR.SOEGIRI. LAMONGAN JL. KUSUMA BANGSA NO.7 321718

DR. YULIARTO DWI MARTONO, MMKES PER/4/042016

RS.TRAUMA CENTRE 06/04/2016 31/12/2017

23 1500000001403RUMAH SAKIT ISLAM MUHAMMADIYAH SUMBERREJO BOJONEGORO

JL. RAYA SUMBERREJO NO.1193 SUMBERREJO

331056DR.H.TOMY OEKY PRASISKA


03/06/2016 31/12/2017

24 1500000001403RUMAH SAKIT ISLAM MUHAMMADIYAH SUMBERREJO BOJONEGORO

JL. RAYA SUMBERREJO NO.1193 SUMBERREJO

331056 DR.H.TOMY OEKY PRASISKA


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


369 / 44607-11-201606:23:31



IKS


25 1500000001402RUMAH SAKIT KHUSUS BEDAH "PEMUDA" BOJONEGORO

JL. PEMUDA NO. 29 887749 DR.M.NAQVI ALFARISI PER/14/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

KANTOR CABANG : N11- KANTOR CABANG SIDOARJO


IKS


1 7-3207037624 KLINIK ASY SYIFA PPDFP JL RAYA BENDOMUNGAL SIDOREJO KRIAN 61214YAYASAN DALILUL FALIHIN PONPES DARUL FALAH PUSAT


2 1500000000354 KLINIK CENDEKIA HUSADAJL RAYA LINGKAR TIMUR RANGKAH KIDUL 8944584 DR DRS H SOEHARTO SH PER/06/032016

RS.TRAUMA CENTRE 23/05/2016 31/12/2016

3 1500000000354 KLINIK CENDEKIA HUSADA JL RAYA LINGKAR TIMUR RANGKAH KIDUL

8944584 DR DRS H SOEHARTO SH PER/12/032015 RS.TRAUMA CENTRE

01/03/2015 29/02/2016

4 1400000000600 KLINIK CITRA GADING MEDIKA

JL BRIGJEND KATAMSO A408-409 REWWIN WARU

8679727 IR SAD INDAH AMBARWATI


21/12/2015 30/11/2016

5 1500000000917 KLINIK HABIBAHJL RAYA CANGKRING RT 07 RW 02 KREMBUNG 8856706 DR WIWIK SETYORINI PER/15/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

6 1500000000917 KLINIK HABIBAHJL RAYA CANGKRING RT 07 RW 02 KREMBUNG 8856706 DR WIWIK SETYORINI PER/02/052016

RS.TRAUMA CENTRE 23/06/2016 31/12/2016

7 1500000000918 KLINIK HABIBAH 2DS PILANG BANGU RT 08 RW 03 BALONG BENDO

8979631 DR WIWIK SETYORINI PER/15/052015RS.TRAUMA CENTRE

01/05/2015 30/04/2016

8 1500000000918 KLINIK HABIBAH 2 DS PILANG BANGU RT 08 RW 03 BALONG BENDO

8979631 DR WIWIK SETYORINI PER/02/052016 RS.TRAUMA CENTRE

23/06/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


370 / 44607-11-201606:23:31



IKS


9 1500000001652 KLINIK POLRES SIDOARJO JL KOMBES POL MOH DURYAT 45 PER/06/062016 RS.TRAUMA CENTRE 22/06/2015 21/06/2017

10 1500000000172KLINIK PRATAMA RAWAT JALAN & RAWAT INAP "BDS TEBEL" 24 JAM

JL TEBEL BARAT NO 1-3 8911555 PER/08/022015 RS.TRAUMA CENTRE 01/02/2015 31/01/2016

11 1500000000172KLINIK PRATAMA RAWAT JALAN & RAWAT INAP "BDS TEBEL" 24 JAM

JL TEBEL BARAT NO 1-3 8911555 PER/01/022016 RS.TRAUMA CENTRE

18/04/2016 31/12/2016

12 7-4408123263 KLINIK RAHMAN RAHIM 2 TROSOBO

JL TROSOBO UTAMA 1A/T 61212 0317882685

DR HENDRA KURNIAWAN PUTRA


19/08/2016 31/12/2017

13 1500000000605 KRIYANDAS NURANI JL RAYA KEBONAGUNG NO 48 SUKODONO 58834697 CV NURANI PER/07/042016 RS.TRAUMA CENTRE 31/08/2016 31/12/2016

14 1500000000605 KRIYANDAS NURANI JL RAYA KEBONAGUNG NO 48 SUKODONO 58834697 CV NURANI PER/13/042015 FFS 01/04/2015 31/03/2016

15 1500000001401 PUSKESMAS BALONGBENDO

JL MAYJEN BAMBANG SUWONO NO 11 SEDURI


01/01/2016 31/12/2016

16 1500000001401 PUSKESMAS BALONGBENDO

JL MAYJEN BAMBANG SUWONO NO 11 SEDURI


01/06/2015 31/12/2015

17 1500000001372PUSKESMAS BARENGKRAJAN DS BARENGKRAJAN KEC KRIAN PER/16/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

18 1500000001372PUSKESMAS BARENGKRAJAN DS BARENGKRAJAN KEC KRIAN PER/26/122015

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

19 1500000001363 PUSKESMAS BUDURAN JL JAWA NO 2 KEC BUDURAN PER/26/122015RS.TRAUMA CENTRE

01/01/2016 31/12/2016

20 1500000001363 PUSKESMAS BUDURAN JL JAWA NO 2 KEC BUDURAN PER/16/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


371 / 44607-11-201606:23:31



IKS


21 1500000001354 PUSKESMAS CANDI JL M RIDWAN NO 5 GELAM KEC CANDI PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

22 1500000001354 PUSKESMAS CANDI JL M RIDWAN NO 5 GELAM KEC CANDI PER/16/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

23 1500000001368 PUSKESMAS GANTING JL SINGO MENGGOLO NO 1 DS GANTING PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

24 1500000001368 PUSKESMAS GANTING JL SINGO MENGGOLO NO 1 DS GANTING PER/16/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

25 1500000001367 PUSKESMAS GEDANGAN JL RAYA GEDANGAN 330 KEC GEDANGAN PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

26 1500000001367 PUSKESMAS GEDANGAN JL RAYA GEDANGAN 330 KEC GEDANGAN PER/16/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

27 1500000001352 PUSKESMAS JABON JL DUKUH SARI KEC JABON PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

28 1500000001352 PUSKESMAS JABON JL DUKUH SARI KEC JABON PER/16/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

29 1500000001346 PUSKESMAS KEDUNG SOLO DS KEDUNG SOLO KEC PORONG PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

30 1500000001346 PUSKESMAS KEDUNG SOLO DS KEDUNG SOLO KEC PORONG PER/16/062016RS.TRAUMA CENTRE 01/06/2015 31/12/2015

31 1500000001356 PUSKESMAS KEPADANGAN DS KEPADANGAN KEC TULANGAN PER/16/062015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

32 1500000001356 PUSKESMAS KEPADANGAN DS KEPADANGAN KEC TULANGAN PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


372 / 44607-11-201606:23:31



IKS


33 1500000001344 PUSKESMAS KREMBUNG JL SUNGAI KAPUAS NO 2 KEC KREMBUNG PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

34 1500000001344 PUSKESMAS KREMBUNG JL SUNGAI KAPUAS NO 2 KEC KREMBUNG PER/16/062016 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

35 1500000001371 PUSKESMAS KRIAN JL SETIA BUDI KEC KRIAN PER/16/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

36 1500000001371 PUSKESMAS KRIAN JL SETIA BUDI KEC KRIAN PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

37 1500000001366 PUSKESMAS MEDAENG JL JOYOBOYO 40 MEDAENG KEC WARU PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

38 1500000001366 PUSKESMAS MEDAENG JL JOYOBOYO 40 MEDAENG KEC WARU PER/16/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

39 1500000001345 PUSKESMAS PORONG JL JUWET UTARA 265 KEC PORONG PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

40 1500000001345 PUSKESMAS PORONG JL JUWET UTARA 265 KEC PORONG PER/16/062016 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

41 1500000001343 PUSKESMAS PRAMBON JL RAYA PRAMBAON KEC PRAMBON PER/16/062016RS.TRAUMA CENTRE 01/06/2015 31/12/2015

42 1500000001343 PUSKESMAS PRAMBON JL RAYA PRAMBAON KEC PRAMBON PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

43 1500000001364 PUSKESMAS SEDATI DS BETRO KEC SEDATI PER/16/062015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

44 1500000001364 PUSKESMAS SEDATI DS BETRO KEC SEDATI PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


373 / 44607-11-201606:23:31



IKS


45 1500000001361 PUSKESMAS SEKARDANGAN JL WIJAYA KUSUMA NO 91 SEKARDANGAN PER/16/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

46 1500000001361 PUSKESMAS SEKARDANGAN JL WIJAYA KUSUMA NO 91 SEKARDANGAN PER/26/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

47 1500000001359 PUSKESMAS SIDOARJO JL DR SOETOMO NO 14 KEC SIDOARJO PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

48 1500000001359 PUSKESMAS SIDOARJO JL DR SOETOMO NO 14 KEC SIDOARJO PER/16/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

49 1500000001358 PUSKESMAS SUKODONO DS PEKARUNGAN KEC SUKODONO PER/16/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

50 1500000001358 PUSKESMAS SUKODONO DS PEKARUNGAN KEC SUKODONO PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

51 1500000001369 PUSKESMAS TAMAN JL RAYA NGELOM 50 KEC TAMAN PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

52 1500000001369 PUSKESMAS TAMAN JL RAYA NGELOM 50 KEC TAMAN PER/16/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

53 1500000001353PUSKESMAS TANGGULANGIN

JL RAYA PUTAT NO 38 KEC TANGGULANGIN PER/26/122015

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

54 1500000001353PUSKESMAS TANGGULANGIN

JL RAYA PUTAT NO 38 KEC TANGGULANGIN PER/16/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

55 1500000001342 PUSKESMAS TARIK JL RAYA KEMUNING KEC TARIK PER/16/062016RS.TRAUMA CENTRE

01/06/2015 31/12/2015

56 1500000001342 PUSKESMAS TARIK JL RAYA KEMUNING KEC TARIK PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


374 / 44607-11-201606:23:31



IKS


57 1500000001370 PUSKESMAS TROSOBO JL RAYA TROSOBO KEC TAMAN PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

58 1500000001370 PUSKESMAS TROSOBO JL RAYA TROSOBO KEC TAMAN PER/16/062015 RS.TRAUMA CENTRE 01/06/2015 31/12/2015

59 1500000001355 PUSKESMAS TULANGAN JL RAYA KEMANTREN KEC TULANGAN PER/26/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

60 1500000001355 PUSKESMAS TULANGAN JL RAYA KEMANTREN KEC TULANGAN PER/16/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

61 1500000001360 PUSKESMAS URANGAGUNG JL RAYA CEMENG KALANG KEC SIDOARJO PER/26/122015 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

62 1500000001360 PUSKESMAS URANGAGUNG JL RAYA CEMENG KALANG KEC SIDOARJO PER/16/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

63 1500000001365 PUSKESMAS WARU JL BARITO POJOK NO 1 WISTROP KEC WARU


01/01/2016 31/12/2016

64 1500000001365 PUSKESMAS WARU JL BARITO POJOK NO 1 WISTROP KEC WARU


01/06/2015 31/12/2015

65 1500000001357 PUSKESMAS WONOAYU JL WONOAYU KEC WONOAYU PER/16/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

66 1500000001357 PUSKESMAS WONOAYU JL WONOAYU KEC WONOAYU PER/26/122015RS.TRAUMA CENTRE 01/01/2016 31/12/2016

67 7-3489506297 RS AISYIYAH SITI FATIMAH JL RAYA KENONGO NO 14 TULANGAN 612730318856303

PP MUHAMMADIYAH PER/11/052016RS.TRAUMA CENTRE

23/05/2016 31/12/2016

68 1400000000563 RS BHAYANGKARA PUSDIK GASUM PORONG

JL RAYA PORONG NO 1 852104 POLRI PER/18/122015 RS.TRAUMA CENTRE

21/12/2015 30/11/2016


Periode : 01/01/2015 s/d 31/10/2016


375 / 44607-11-201606:23:31



IKS


69 1400000000128 RS BUNDA SIDOARJO JL KUNDI NO 70 KEPUH KIRIMAN WARU 8668880 PT PERMATA BUNDA BERSAMA PER/04/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

70 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

71 0800000000036 RS CITRA MEDIKA JL.RAYA SURABAYA-MOJOKERTO KM 44 361000 PER/02/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

72 0800000000036 RS CITRA MEDIKA JL.RAYA SURABAYA-MOJOKERTO KM 44 361000 PER/21/122015 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

73 1500000000736 RS ISLAM SITI HAJAR JL RADEN PATAH 70-72 8921233 BPM NU SITI HAJAR PER/14/052015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

74 1500000000736 RS ISLAM SITI HAJAR JL RADEN PATAH 70-72 8921233 BPM NU SITI HAJAR PER/08/042016RS.TRAUMA CENTRE 14/07/2016 31/12/2016

75 1300000000030 RS SITI KHODIJAH JL PAHLAWAN NO 260 SEPANJANG 7882123 YYS MUHAMMADIYAH PER/23/12205 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

76 1300000000030 RS SITI KHODIJAH JL PAHLAWAN NO 260 SEPANJANG 7882123 YYS MUHAMMADIYAH PER/03/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

77 7-3200248883RSIA ARAFAH ANWAR MEDIKA SUKODONO JL SAWO NO 2 SUKODONO 61258

0318830989 DR ISKANDAR ALI PER/08/052016

RS.TRAUMA CENTRE 09/05/2016 31/12/2016

78 7-4248673408RSU AL ISLAM HM MAWARDI JL KYAI MOJO 12A JERUK GAMPING KRIAN 61262

0318973379 YAPALIS PER/16/082016

RS.TRAUMA CENTRE 02/08/2016 31/12/2017

79 1400000000278 RSU ANWAR MEDIKAJL RAYA BY PASS KRIAN KM 33 BALONGBENDO

8974943YAYASAN RUMAH SAKITANWAR MEDIKA


01/01/2015 31/12/2015

80 1400000000278 RSU ANWAR MEDIKA JL RAYA BY PASS KRIAN KM 33 BALONGBENDO

8974943 YAYASAN RUMAH SAKITANWAR MEDIKA


01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


376 / 44607-11-201606:23:31



IKS


81 1200000000014 RSU JASEM JL KH SAMANHUDI NO 85 8962129 YAYASAN USADA KARYA PER/24/122015 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

82 1200000000014 RSU JASEM JL KH SAMANHUDI NO 85 8962129 YAYASAN USADA KARYA PER/05/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

83 0700000000008 RSUD SIDOARJO JL MAJAPAHIT NO 667 8961649 PER/01/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

84 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 1500000000811 BP PANGLIMA SUDIRMAN GRESIK

JL PANGLIMA SUDIRMAN 08563186435

YUNI HIDAYATI PER/12/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

2 1500000000811BP PANGLIMA SUDIRMAN GRESIK JL PANGLIMA SUDIRMAN

08563186435 YUNI HIDAYATI PER/12/012016

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

3 1500000001618 FKTP POLRES GRESIK JL BASUKI RAHMAT 2 GRESIK DR. BUDIYONO, MARS PER/14/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

4 1500000001618 FKTP POLRES GRESIK JL BASUKI RAHMAT 2 GRESIK DR. BUDIYONO, MARS PER/14/012016RS.TRAUMA CENTRE

01/01/2016 31/12/2016

5 1500000000810 KLINIK HIDAYAH MANYAR MANYAR RESORT 08563186435

YUNI HIDAYATI PER/11/052015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


377 / 44607-11-201606:23:31



IKS


6 1500000000810 KLINIK HIDAYAH MANYAR MANYAR RESORT 08563186435 YUNI HIDAYATI PER/11/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

7 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

8 7-3641074493 KLINIK RAWAT INAP PUSPA ARUNDAYA

JL RAYA WRINGINANOM NO 1 61111 0318986444

DRG. MOHD. RIZAL NANDY PRADIPTA


06/06/2016 31/12/2016

9 1500000000893 PUSKESMAS ALUN ALUN GRESIK

JL. PAHLAWAN GRESIK 3981865 DR. ACH SYAFI'I PER/05/012015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

10 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

11 1500000001569PUSKESMAS BALONGPANGGANG GRESIK

RAYA KEDUNGPRING 8 BALONGPANGGANG GRESIK 7921007 DR RINI SULISTYOASIH PER/05/012015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

12 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

13 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

14 1500000001572PUSKESMAS BENJENG GRESIK JL. RAYA NYAYAT 34 BENJENG GRESIK 7921167 DR SONY PER/05/012015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

15 1500000001492PUSKESMAS BUNGAH GRESIK JL RAYA BUNGAH 15 GRESIK 3949600

DRG TITY KARYATI PANIGORO PER/05/012015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

16 1500000001492PUSKESMAS BUNGAH GRESIK

JL RAYA BUNGAH 15 GRESIK 3949600DRG TITY KARYATI PANIGORO


01/01/2016 31/12/2016

17 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


Periode : 01/01/2015 s/d 31/10/2016


378 / 44607-11-201606:23:31



IKS


18 1500000000757 PUSKESMAS CERME GRESIK JL RAYA CERME KIDUL 52 CERME 7990007 DR LESTARI PER/05/012015 RS.TRAUMA CENTRE 01/05/2015 31/12/2015

19 1500000001573 PUSKESMAS DADAP KUNING GRESIK JL. RAYA DADAP KUNING 32 GRESIK 7990510 DR GATOT PURNOMO PER/05/012015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

20 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

21 1500000001570 PUSKESMAS DAPET GRESIK RAYA TANAH LENDEAN 49 BALONGPANGGANG GRESIK

70953980 DR SOESILO PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

22 1500000001570 PUSKESMAS DAPET GRESIK RAYA TANAH LENDEAN 49 BALONGPANGGANG GRESIK 70953980 DR SOESILO PER/05/012015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

23 1500000000741PUSKESMAS DRIYOREJO GRESIK RAYA DRIYOREJO GRESIK 23264794 DR DANIEL SA'U PER/05/012016

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

24 1500000000741 PUSKESMAS DRIYOREJO GRESIK

RAYA DRIYOREJO GRESIK 23264794 DR DANIEL SA'U PER/05/012015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

25 1500000001571 PUSKESMAS DUDUK SAMPEYAN GRESIK

RAYA DUDUK SAMPEYAN 45 DUDUK SAMPEYAN GRESIK

3903118 DRG NANIK LESTARI PER/05/012015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

26 1500000001571PUSKESMAS DUDUK SAMPEYAN GRESIK

RAYA DUDUK SAMPEYAN 45 DUDUK SAMPEYAN GRESIK 3903118 DRG NANIK LESTARI PER/05/012016

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

27 1500000001489 PUSKESMAS DUKUN GRESIKJL RAYA SEMBUNGAN KIDUL 37 DUKUN GRESIK 3949299 DRG SAIFUDIN GOZALI PER/05/012016

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

28 1500000001489 PUSKESMAS DUKUN GRESIKJL RAYA SEMBUNGAN KIDUL 37 DUKUN GRESIK

3949299 DRG SAIFUDIN GOZALI PER/05/012015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

29 1500000000742 PUSKESMAS GENDING GRESIK

JL VETERAN GRESIK 3985872 DRG HELENA SUZANA PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


379 / 44607-11-201606:23:31



IKS


30 1500000000742 PUSKESMAS GENDING GRESIK JL VETERAN GRESIK 3985872 DRG HELENA SUZANA PER/05/012015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

31 1500000000892 PUSKESMAS INDUSTRI GRESIK JL. ARIEF RAHMAN HAKIM 100 GRESIK 3985877 DRG ANISAH

MAHMUDAH PER/05/012015 RS.TRAUMA CENTRE 01/05/2015 31/12/2015

32 1500000000892 PUSKESMAS INDUSTRI GRESIK

JL. ARIEF RAHMAN HAKIM 100 GRESIK 3985877 DRG ANISAH MAHMUDAH


01/01/2016 31/12/2016

33 1500000000890 PUSKESMAS KARANGANDONG GRESIK

RAYA KARANGANDONG DRIYOREJO GRESIK

7911659 DR SITI HAFIDA PER/05/012015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

34 1500000000890 PUSKESMAS KARANGANDONG GRESIK

RAYA KARANGANDONG DRIYOREJO GRESIK 7911659 DR SITI HAFIDA PER/05/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

35 1500000000894PUSKESMAS KEBOMAS GRESIK JL SUNAN GIRI III/1 GRESIK 3985880

DR. RAHAJU NUGRAHANI PER/05/012015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

36 1500000000894 PUSKESMAS KEBOMAS GRESIK

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


01/01/2016 31/12/2016

37 1500000000755 PUSKESMAS KEDAMEAN GRESIK

RAYA KEDAMEAN NO 1 GRESIK 7911437 DR. HILDA BETSY PER/05/012015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

38 1500000000755PUSKESMAS KEDAMEAN GRESIK RAYA KEDAMEAN NO 1 GRESIK 7911437 DR. HILDA BETSY PER/05/012016

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

39 1500000001565PUSKESMAS KEPATIHAN GRESIK RAYA KEPATIHAN 151 7991403 DRG TITIEK SRI HAJATI PER/05/012016

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

40 1500000001565PUSKESMAS KEPATIHAN GRESIK

RAYA KEPATIHAN 151 7991403 DRG TITIEK SRI HAJATI PER/05/012015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

41 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


Periode : 01/01/2015 s/d 31/10/2016


380 / 44607-11-201606:23:31



IKS


42 1500000001566 PUSKESMAS KESAMBEN KULON GREIK

KESAMBEN KULON WRINGINANOM GRESIK 60438431 SIDIK NURDIJANTO, SKM PER/05/012015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

43 1500000001617 PUSKESMAS MANYAR GRESIK JL RAYA MANYAR 1 GRESIK DRG JON SUDIRO PER/05/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

44 1500000001617 PUSKESMAS MANYAR GRESIK

JL RAYA MANYAR 1 GRESIK DRG JON SUDIRO PER/05/012015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

45 1500000000756 PUSKESMAS MENGANTI GRESIK

JL RAYA MENGANTI 225 MENGANTI 7911360 DRG TJAHYONO EDY W PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

46 1500000000756 PUSKESMAS MENGANTI GRESIK JL RAYA MENGANTI 225 MENGANTI 7911360 DRG TJAHYONO EDY W PER/05/012015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

47 1500000001490PUSKESMAS MENTARAS GRESIK JL. RAYA MENTARAS DUKUN GRESIK 70954039 DR. RIZAUL FALAH PER/05/012015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

48 1500000001490 PUSKESMAS MENTARAS GRESIK

JL. RAYA MENTARAS DUKUN GRESIK 70954039 DR. RIZAUL FALAH PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

49 1500000001568 PUSKESMAS METATU GRESIK

JL. RAYA METATU 1 GRESIK 7991220 EKO HARIANTO, SKM PER/05/012015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

50 1500000001568PUSKESMAS METATU GRESIK JL. RAYA METATU 1 GRESIK 7991220 EKO HARIANTO, SKM PER/05/012016

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

51 1500000001564PUSKESMAS NELAYAN GRESIK JL. GUB SURYO 33 GRESIK 3983036 DRG PEKIK PITA M PER/05/012016

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

52 1500000001564PUSKESMAS NELAYAN GRESIK

JL. GUB SURYO 33 GRESIK 3983036 DRG PEKIK PITA M PER/05/012015RS.TRAUMA CENTRE

01/06/2015 31/12/2015

53 1500000001488 PUSKESMAS PANCENG GRESIK

JL RAYA PANCENG GRESIK 3940118 DR. JAIMAN PER/05/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


381 / 44607-11-201606:23:31



IKS


54 1500000001488 PUSKESMAS PANCENG GRESIK JL RAYA PANCENG GRESIK 3940118 DR. JAIMAN PER/05/012015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

55 1500000001560 PUSKESMAS SEKAPUK GRESIK

JK RAYA DS SEKAPUK 15 UJUNG PANGKAH GRESIK 3948128 DR MUJTAHIDAH PER/05/012015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

56 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

57 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

58 1500000001563 PUSKESMAS SEMBAYAT GRESIK JL. PENDOPO NO 1 SEMBAYAT GRESIK 3949800 DR TITIK ERNA PER/05/012015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

59 1500000001491PUSKESMAS SIDAYU GRESIK JL KANJENG PANGERAN 1 GRESIK 3949100 DR WIWIK SUSANTI PER/05/012015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

60 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

61 1500000001567 PUSKESMAS SLEMPIT GRESIK

RAYA SLEMPIT KEDAMEAN GRESIK 7911963 DR. SUKADI PER/05/012015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

62 1500000001567PUSKESMAS SLEMPIT GRESIK RAYA SLEMPIT KEDAMEAN GRESIK 7911963 DR. SUKADI PER/05/012016

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

63 1500000000175 PUSKESMAS SUKOMULYO JL. KALIMANTAN NO.104 GKB GRESIK 3954818 DR LESTARI PER/05/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

64 1500000000175 PUSKESMAS SUKOMULYO JL. KALIMANTAN NO.104 GKB GRESIK 3954818 DR LESTARI PER/05/012015RS.TRAUMA CENTRE

01/02/2015 31/12/2015

65 1500000001562 PUSKESMAS UJUNG PANGKAH GRESIK

JL SITARDA 14 PANGKAH GRESIK 3944760 DR SETYORINI PER/05/012015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


382 / 44607-11-201606:23:31



IKS


66 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

67 1500000000889 PUSKESMAS WRINGINANOMGRESIK

RAYA WRINGINANOM 111 WRINGINANOM GRESIK 8975330 DR BUDI LUHUR PER/05/012016 RS.TRAUMA

CENTRE 01/01/2016 31/12/2016

68 1500000000889 PUSKESMAS WRINGINANOMGRESIK

RAYA WRINGINANOM 111 WRINGINANOM GRESIK

8975330 DR BUDI LUHUR PER/05/012015 RS.TRAUMA CENTRE

01/05/2015 31/12/2015

69 1500000000808 RACHMIE CLINIC CERME JL RAYA GURANGANYAR NO 23 CERME 331284499 DR. RAHMI ZUBAIDAH, SP.MK


01/01/2016 31/12/2016

70 1500000000808 RACHMIE CLINIC CERME JL RAYA GURANGANYAR NO 23 CERME 331284499 DR. RAHMI ZUBAIDAH, SP.MK PER/08/052015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

71 1500000000807RACHMIE CLINIC DUDUK SAMPEYAN

RUKO D RAYA REGENCY R1 DUDUK SAMPEYAN GRESIK 331284499

DR RAHMI ZUBAIDAH, SPMK PER/09/052015

RS.TRAUMA CENTRE 01/05/2015 31/12/2015

72 1500000000807 RACHMIE CLINIC DUDUK SAMPEYAN

RUKO D RAYA REGENCY R1 DUDUK SAMPEYAN GRESIK

331284499 DR RAHMI ZUBAIDAH, SPMK


01/01/2016 31/12/2016

73 1500000001983 RS FATHMA MEDIKA JL. PENDOPO 45 SEMBAYAT MANYAR 61111 3943500 DR. ASLUCHUL ALIF PER/15/102015 RS.TRAUMA CENTRE

01/10/2015 31/12/2015

74 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

75 0900000000039 RS PETRO KIMIA GRESIK JL JEND A YANI 69 3976688DR.SINGGIH PRIYANTO, MARS PER/02/012015

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

76 0900000000039 RS PETRO KIMIA GRESIK JL JEND A YANI 69 3976688DR.SINGGIH PRIYANTO, MARS


01/01/2016 31/12/2016

77 7-140944846 RS SURYA MEDIKA JL LABAN KULON 61111 0313972121

DR RAMLI TARIGAN PER/16/102015 RS.TRAUMA CENTRE

01/10/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


383 / 44607-11-201606:23:31



IKS


78 1500000001993 RS SURYA MEDIKA GRESIK LABAN KULON 58 MENGANTI 61174 7914025 RS RAMLI TARIGAN PER/16/102015 RS.TRAUMA CENTRE 01/10/2015 31/12/2015

79 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

80 1500000001519 RS WATES HUSADA RAYA BALONG PANGGANG GRESIK DR TITIN PER/13/012016 RS.TRAUMA CENTRE

01/01/2016 31/12/2016

81 1500000001519 RS WATES HUSADA RAYA BALONG PANGGANG GRESIK DR TITIN PER/13/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

82 1400000000364 RS.MUHAMMADIYAH GRESIK JL.KH.KHOLIL NO.88 3981275 DR.MUSA GHUFRON PER/04/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

83 1400000000364RS.MUHAMMADIYAH GRESIK JL.KH.KHOLIL NO.88 3981275 DR.MUSA GHUFRON PER/04/012016

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

84 1400000000363 RSI DARUS SYIFA' BENOWO JL.RAYA BENOWO NO.5 BENOWO 7406293 DR.HM.FAIZ, SP.THT-KL PER/03/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

85 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

86 7-4948495563 RSU WALI SONGO 1 GRESIKRAYA BALONGPANGGANG -MOJOKERTO KM. 4 GRESIK 61173

ARIF HANDOKO, SE, SH, M.HUM PER/019/092016

RS.TRAUMA CENTRE 07/10/2016 31/12/2017

87 0900000000002 RSUD IBNU SINA GRESIK JL DR WAHIDIN SHD NO 243B 3951239 DR. ENDANG S, SP.THT PER/01/012016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

88 0900000000002 RSUD IBNU SINA GRESIK JL DR WAHIDIN SHD NO 243B 3951239 DR. ENDANG S, SP.THT PER/01/012015RS.TRAUMA CENTRE

01/01/2015 31/12/2015

89 7-140917243 RUMAS SAKIT FATHMA MEDIKA

JL PENDOPO 45 MANYAR 61151 DR ASLUCHUL PER/15/102015 RS.TRAUMA CENTRE

01/10/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


384 / 44607-11-201606:23:31



IKS


90 1500000000809 SURYA GIRI JAYA CERME JL. RAYA CERME GRESIK 63186435 YUNI HIDAYATI PER/10/012016 RS.TRAUMA CENTRE 01/01/2016 31/12/2016

91 1500000000809 SURYA GIRI JAYA CERME JL. RAYA CERME GRESIK 63186435 YUNI HIDAYATI PER/10/052015 RS.TRAUMA CENTRE 01/05/2015 31/12/2015

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/21/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

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

29/01/2016 31/12/2016

3 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

4 1500000001445 BP HIDAYAH WARU IV JL GRAHA TIRTA RAYA I NO.28 WARU 70350252 CV KEMBANG TANJUNG PER/18/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

5 1500000001444 BP KEBANGKITAN JL MANUKAN MADYA 141 SURABAYA 71258886 CV KEMBANG TANJUNG PER/22/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

6 1500000001444 BP KEBANGKITAN JL MANUKAN MADYA 141 SURABAYA 71258886 CV KEMBANG TANJUNG PER/08/012016RS.TRAUMA CENTRE

01/02/2016 31/12/2016

7 1500000001443 BP KESAYANGAN JL RUNGKUT ASRI UTARA IV/10 (RL I/H-5) SURABAYA

8700691 CV KEMBANG TANJUNG PER/20/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


385 / 44607-11-201606:23:31



IKS


8 1500000001443 BP KESAYANGAN JL RUNGKUT ASRI UTARA IV/10 (RL I/H-5) SURABAYA 8700691 CV KEMBANG TANJUNG PER/09/012016 RS.TRAUMA

CENTRE 01/02/2016 31/12/2016

9 1500000001446 BP KESEJAHTERAAN JL RUNGKUT MAPAN UTARA AA-17 SURABAYA 8706755 CV KEMBANG TANJUNG PER/19/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

10 1500000001446 BP KESEJAHTERAAN JL RUNGKUT MAPAN UTARA AA-17 SURABAYA

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

01/02/2016 31/12/2016

11 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

12 1500000001335 KLINIK CITRA MEDICAL CENTRE JL KETINTANG BARU III/56 SURABAYA 8291214 DR SAID MOHAMMAD T PER/09/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

13 1500000001393 KLINIK KARYA MEDIKA 104 JL BANYU URIP NO 302 SURABAYA 5324326 CV KARYA MEDIKA PER/16/012016RS.TRAUMA CENTRE 01/02/2016 31/12/2016

14 1500000001393 KLINIK KARYA MEDIKA 104 JL BANYU URIP NO 302 SURABAYA 5324326 CV KARYA MEDIKA PER/16/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

15 1500000001394 KLINIK KARYA MEDIKA 111 BUKIT CITRA DARMO BLOK BC C30/JL KLAKAH REJO I-20 SURABAYA

CV KARYA MEDIKA PER/17/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

16 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

17 1500000001395 KLINIK KARYA MEDIKA 41 JL NGAGLIK NO 47 SURABAYA 3764782 CV KARYA MEDIKA PER/15/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

18 1500000001395 KLINIK KARYA MEDIKA 41 JL NGAGLIK NO 47 SURABAYA 3764782 CV KARYA MEDIKA PER/18/012016RS.TRAUMA CENTRE

01/02/2016 31/12/2016

19 1500000001379 KLINIK SARTIKA 36 BRATANG BINANGUN GANG VI/47 SURABAYA

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

01/02/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


386 / 44607-11-201606:23:31



IKS


20 1500000001379 KLINIK SARTIKA 36 BRATANG BINANGUN GANG VI/47 SURABAYA 34417343 DR LILIK SRI HARTINI PER/10/062015 RS.TRAUMA

CENTRE 01/06/2015 31/12/2015

21 1500000001377 KLINIK SARTIKA 44 JL RAYA MASTRIP NO 32 KARANG PILANG SURABAYA 34200705 DR LILIK SRI HARTINI PER/12/012016 RS.TRAUMA

CENTRE 01/02/2016 31/12/2016

22 1500000001377 KLINIK SARTIKA 44 JL RAYA MASTRIP NO 32 KARANG PILANG SURABAYA


01/06/2015 31/12/2015

23 1500000001376 KLINIK SARTIKA 59 JL MANUKAN TENGAH 9K/10 SURABAYA 34183507 DR LILIK SRI HARTINI PER/12/062015 RS.TRAUMA CENTRE

01/06/2015 31/12/2015

24 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

25 1500000001317 KLINIK SARTIKA 77 JL TRUNOJOYO NO 2 SEPANJANG 7871549 DR LILIK SRI HARTINI PER/08/062015RS.TRAUMA CENTRE 01/06/2015 31/12/2015

26 1500000001317 KLINIK SARTIKA 77 JL TRUNOJOYO NO 2 SEPANJANG 7871549 DR LILIK SRI HARTINI PER/14/012016 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

27 N13 POLI SARTIKA 36 BRATANG BINANGUN GANG VI/47 SURABAYA


01/06/2015 31/12/2015

28 1500000001373 POLIKLINIK PUTRI RAHAYUJL MASTRIP IX/9 WARUGUNUNG KARANGPILANG 7667983 BILAL ZAENAL ABIDIN PER/05/012016

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

29 1500000001373 POLIKLINIK PUTRI RAHAYUJL MASTRIP IX/9 WARUGUNUNG KARANGPILANG 7667983 BILAL ZAENAL ABIDIN PER/13/062015

RS.TRAUMA CENTRE 01/06/2015 31/12/2015

30 1100000000018 RS BHAKTI RAHAYU (TC) JL KETINTANG MADYA I / 6 SURABAYA 8289668 PT BHAKTI RAHAYU PER/03/012015RS.TRAUMA CENTRE

01/01/2015 31/12/2015

31 1100000000018 RS BHAKTI RAHAYU (TC) JL KETINTANG MADYA I / 6 SURABAYA 8289668 PT BHAKTI RAHAYU PER/03/012016 RS.TRAUMA CENTRE

07/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


387 / 44607-11-201606:23:31



IKS


32 1100000000008 RS BUNDA SURABAYA JL RAYA KANDANGAN 23-24 7440077 PT PERMATA BUNDA BERSAMA PER/02/012015 RS.TRAUMA

CENTRE 04/01/2016 31/12/2016

33 1100000000008 RS BUNDA SURABAYA JL RAYA KANDANGAN 23-24 7440077 PT PERMATA BUNDA BERSAMA PER/02/012015 RS.TRAUMA

CENTRE 31/08/2016 31/12/2017

34 1100000000008 RS BUNDA SURABAYA JL RAYA KANDANGAN 23-24 7440077 PT PERMATA BUNDA BERSAMA


01/01/2015 31/12/2015

35 7-3760044943 RS JIWA MENUR SURABAYA JL MENUR 120 60118 PEMERINTAH PROV.JATIM


14/06/2016 31/12/2017

36 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

37 0900000000003 RS MUJI RAHAYUJL RY MANUKAN WETAN 68-68A SURABAYA 7404132 YAYASAN MUJI RAHAYU PER/04/012015

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

38 1100000000019 RS WIJAYA (TC) JL RAYA MENGANTI WIYUNG NO 398 SURABAYA

7523087 YAYASAN WIJAYA PER/02/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

39 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 1500000000728 BP KLINIK INDO SEHAT 2003 JL. WONOSARI LOR 99-101 (RUKO AMIRA GRAHA BLOK A/2) SURABAYA

3761150 HASAN BASRI PER/07/042015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


388 / 44607-11-201606:23:31



IKS


2 1500000000728 BP KLINIK INDO SEHAT 2003 JL. WONOSARI LOR 99-101 (RUKO AMIRA GRAHA BLOK A/2) SURABAYA 3761150 HASAN BASRI PER/O8/052016 RS.TRAUMA

CENTRE 23/05/2016 30/04/2017

3 1500000000953 BP PERDANA HUSADA MANUKAN KRAJAN 32Q/2 7403300 PER/09/052016 RS.TRAUMA CENTRE 23/05/2016 30/04/2017

4 1500000000953 BP PERDANA HUSADA MANUKAN KRAJAN 32Q/2 7403300 PER/12/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

5 1500000001612 BP RAJAWALI 1 JL KREMBANGAN BARAT NO 26 D 34061757 DR RR KARTIWI ATMINI PER/10/052016 RS.TRAUMA CENTRE

01/06/2016 31/05/2017

6 1500000001612 BP RAJAWALI 1 JL KREMBANGAN BARAT NO 26 D 34061757 DR RR KARTIWI ATMINI PER/017/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

7 1500000001610 BP SURYA GIRI JAYA JL KENJERAN NO 189 31362696DR RISTA YULIANA SUGIANTO PER/015/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

8 1500000001610 BP SURYA GIRI JAYA JL KENJERAN NO 189 31362696 DR RISTA YULIANA SUGIANTO


01/06/2016 31/05/2017

9 1500000000887 DINAYLA UTAMA 105 RAYA BIBIS NO.36 PER/12/05/2016 RS.TRAUMA CENTRE

23/05/2016 30/04/2017

10 1500000000887 DINAYLA UTAMA 105 RAYA BIBIS NO.36 PER/11/052015RS.TRAUMA CENTRE 01/05/2015 30/04/2016

11 1500000000891 DINAYLA UTAMA 79 SIMOREJO SARI B/54 7496347 PER/09/052015RS.TRAUMA CENTRE 01/05/2015 30/06/2016

12 1500000000891 DINAYLA UTAMA 79 SIMOREJO SARI B/54 7496347 PER/14/052016RS.TRAUMA CENTRE

02/09/2016 30/06/2017

13 1500000000888 DINAYLA UTAMA 84 SIMOPOMAHAN 3/14 3136269 PER/10/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


389 / 44607-11-201606:23:31



IKS


14 1500000000888 DINAYLA UTAMA 84 SIMOPOMAHAN 3/14 3136269 PER/13/052016 RS.TRAUMA CENTRE 23/05/2016 30/04/2017

15 1500000001065 KLINIK MITRA SEHAT JL.RAYA MENGANTI NO.411 PER/15/05/2016 RS.TRAUMA CENTRE 23/05/2016 30/04/2017

16 1500000001065 KLINIK MITRA SEHAT JL.RAYA MENGANTI NO.411 PER/13/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

17 1500000001554 KLINIK NURANI JAYA 121 JL PUTRO AGUNG WETAN NO 58 331212060 PER/16/052016 RS.TRAUMA CENTRE

01/06/2016 31/05/2017

18 1500000001554 KLINIK NURANI JAYA 121 JL PUTRO AGUNG WETAN NO 58 331212060 PER/016/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

19 1500000000737KLINIK PALANG MERAH INDONESIA JL. TAMBAKSARI NO. 49 SURABAYA 5032103 H. IR. TRI SISWANTO. MM PER/06/042015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

20 1500000000737 KLINIK PALANG MERAH INDONESIA

JL. TAMBAKSARI NO. 49 SURABAYA 5032103 H. IR. TRI SISWANTO. MM PER/17/052016 RS.TRAUMA CENTRE

23/05/2016 30/04/2017

21 1400000000517 KLINIK WISMA HUSADA JL DUKUH SETRO 7A KAV NO 2 PER/02/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

22 1400000000517 KLINIK WISMA HUSADA JL DUKUH SETRO 7A KAV NO 2 PER/ 01/ 01-2016RS.TRAUMA CENTRE 01/01/2016 31/12/2016

23 1400000000517 KLINIK WISMA HUSADA JL DUKUH SETRO 7A KAV NO 2 PER/ 02/ 012015 FFS 02/01/2015 31/12/2015

24 0700000000012 RS AL-IRSYAD JL KHM MANSUR 210-214 SURABAYA 3531223DR AHMAD BAKARMAN, MARS


20/01/2016 31/12/2016

25 1500000000726 RS BHAYANGKARA TK. IV M. DAHLAN

JL. SRITI NO. 02 SURABAYA 3551043 DR. SIGIT LESMONOJATI PER/08/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


390 / 44607-11-201606:23:31



IKS


26 1500000000726 RS BHAYANGKARA TK. IV M. DAHLAN JL. SRITI NO. 02 SURABAYA 3551043 DR. SIGIT LESMONOJATI PER/18/052016 RS.TRAUMA

CENTRE 23/05/2016 30/04/2017

27 1400000000469 RUMAH SAKIT PRIMASATYAHUSADA CITRA JL. PRAPAT KURUNG SELATAN NO. 1 3294801

PT RUMAH SAKIT PRIMASATYA HUSADA CITRA

PER/ 01/ 012015 RS.TRAUMA CENTRE 02/01/2015 31/12/2015

28 1400000000469 RUMAH SAKIT PRIMASATYAHUSADA CITRA

JL. PRAPAT KURUNG SELATAN NO. 1 3294801PT RUMAH SAKIT PRIMASATYA HUSADA CITRA


20/01/2016 31/12/2016

KANTOR CABANG : N15- KANTOR CABANG SURABAYA RUNGKUT


IKS


1 1500000001024 KLINIK DINAYLA UTAMA 81 JL. RAYA MARGOREJO NO 8 WONOCOLO SURABAYA

60236 8419906 SITI MURIYAH PER/05/052016 RS.TRAUMA CENTRE

01/06/2016 31/12/2017

2 1500000001024 KLINIK DINAYLA UTAMA 81 JL. RAYA MARGOREJO NO 8 WONOCOLO SURABAYA

60236 8419906 SITI MURIYAH PER/01/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

3 1348KLINIK DOKTER AYOMAN KELUARGA JL SUTOREJO PRIMA UTARA PDD_1 5954477 NIKEN MADIANINGRUM PER/04/052016

RS.TRAUMA CENTRE 01/06/2016 31/12/2017

4 1348KLINIK DOKTER AYOMAN KELUARGA JL SUTOREJO PRIMA UTARA PDD_1 5954477 NIKEN MADIANINGRUM 1346

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

5 7-3922127223KLINIK DOKTER AYOMAN KELUARGA

JL SUTOREJO PRIMA UTARA PDD-1 SURABAYA

60112 59544477NIKEN W MADIANINGRUM


23/06/2016 31/12/2017

6 1100000000011 KLINIK MEDICO SIER RUKO GALAXY SIER, JL. RUNGKUT INDUSTRI III NO. 7-G SURABAYA

60293 70932808 PT PRIMA KARYA BERSAUDARA


28/12/2015 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


391 / 44607-11-201606:23:31



IKS


7 1347 KLINIK NURANI JAYA 37 JL KENDANGSARI GG III NO 20 8483147 NURANI JAYA 1347 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

8 1347 KLINIK NURANI JAYA 37 JL KENDANGSARI GG III NO 20 8483147 NURANI JAYA 1347 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

9 1347 KLINIK NURANI JAYA 37 JL KENDANGSARI GG III NO 20 8483147 NURANI JAYA PER/03/052016 RS.TRAUMA CENTRE

01/06/2016 31/12/2017

10 7-3922662644 KLINIK NURANI JAYA 37 JL KENDANGSARI GG III NO 20 SURABAYA 60239 RAHMAD WAHYUDI PER/03/052016 RS.TRAUMA CENTRE

23/06/2016 31/12/2017

11 1346 KLINIK NURANI JAYA 66 JL KUTISARI SELATAN NO 4 SURABAYA 8473668 KLINIK NURANI 1346 RS.TRAUMA CENTRE 01/06/2015 01/05/2016

12 1346 KLINIK NURANI JAYA 66 JL KUTISARI SELATAN NO 4 SURABAYA 8473668 KLINIK NURANI PER/02/052016RS.TRAUMA CENTRE 01/06/2016 01/12/2017

13 7-3922965915 KLINIK NURANI JAYA 66 JL KUTISARI SELATAN NO 4 SURABAYA 60236 RAHMAD WAHYUDI PER/02/052016 RS.TRAUMA CENTRE

23/06/2016 31/12/2017

14 1400000000361 KLINIK SIER SEJAHTERA JL. RUNGKUT INDUSTRI RAYA NO. 10A 60298 71384589 CV. BANGUN SEJAHTERA PER/01/102015 RS.TRAUMA CENTRE

28/12/2015 31/12/2016

15 7-3127077493RS ANGKATAN LAUT DR. RAMELAN SURABAYA JL. GADUNG NO. 1 SURABAYA 60238

RSAL DR RAMELAN SURABAYA PER/01/042016

RS.TRAUMA CENTRE 01/05/2016 31/12/2017

16 7-804633213RS ISLAM JEMURSARI SURABAYA JL. JEMURSARI NO. 51-57 60236

PROF. DR. DR. ROCHMADROMDONI, SP.PD.,SP.JP(K) PER/01/082015

RS.TRAUMA CENTRE 03/12/2015 31/12/2016

17 1400000000362RS ISLAM SURABAYA A YANI

JL. AHMAD YANI NO. 2 - 4 WONOKROMO 60241 8284505YAYASAN RUMAH SAKITISLAM SURABAYA


28/12/2015 31/12/2016

18 1100000000022 RS ISLAM SURABAYA JEMURSARI

JL JEMURSARI 51-57 60236 847187778 YAYASAN RS ISLAM SURABAYA


08/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


392 / 44607-11-201606:23:31



IKS


19 1500000001994 RS. ROYAL SURABAYA JL. RUNGKUT INDUSTRI I/1 60111 8476111 PT. PRIMA KARYA HUSADA SURABAYA PER/01/102015 RS.TRAUMA

CENTRE 28/10/2015 27/10/2016

KANTOR CABANG : P00- KANTOR CABANG PONTIANAK


IKS


1 1400000000243 RS BHAYANGKARA PONTIANAK JL. KS TUBUN NO. 14 78111 056173661

0 DRG. SUGIYATO PER/12/032016 RS.TRAUMA CENTRE 04/03/2016 28/02/2017

2 1400000000373RS SANTO VINCENTIUS SINGKAWANG JL P DIPONEGORO NO. 5 79123 636768

DR. HUSIN BASIR MSC. M.KES PER/14/042016

RS.TRAUMA CENTRE 11/04/2016 31/03/2017

3 1400000000661 RSUD ADE MUHAMMAD DJOEN SINTANG

JL. PATTIMURA, TANJUNG PURI 78611 22022 DR. HARYSINTO LINOH., MM


20/06/2016 31/12/2017

4 1500000001639 RSUD DR. ABDUL AZIZ SINGKAWANG

JL. DR. SOETOMO SINGKAWANG KALBAR 631798 PER/04/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

5 7-3489389033 RSUD DR. SOEDARSO JL. DR. SOEDARSO NO. 1 781240561737701

DR. YUSTAR MULYADI, SP.PD (K) GEH PER/20/052016

RS.TRAUMA CENTRE 24/05/2016 30/04/2017

6 1400000000383RSUD KABUPATEN SANGGAU JL JENDRAL SUDIRMAN 78511 21070

DR. H. EDY SUPRABOWO,MKM PER/02/012016

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

7 1500000001640 RSUD PEMANGKAT JL A KADIR KASIM NO. 20 PEMANGKATDR SEMUEL GERITS RAHANRA, MPH


01/04/2015 31/03/2016

8 7-4569751453 RUMAH SAKIT CITRA HUSADA

JL. DHARMA BAKTI NO. 45C 79672 056822355 DR. SANTOSO T.,M.SI PER/22/042016 RS.TRAUMA CENTRE

01/09/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


393 / 44607-11-201606:23:31



IKS


9 7-2891931853 RUMAH SAKIT FATIMA JL. JENDRAL SUDIRMAN NO 27 78811 00032814 DR. MARGARETHA INDAH W., MPH PER/16/042016 RS.TRAUMA

CENTRE 12/04/2016 31/03/2017

10 1400000000464 RUMAH SAKIT UMUM BETHESDA SERUKAM

JL. RAYA SINGKAWANG-BENGKAYANG KM48 79281 637019 DR. EDY ARISTON LUBIS,

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

11 7-2877295653 RUMAH SAKIT UMUM PARINDU

DUSUN DOHIK EMPANING DESA BINJAI 78562 DR. HENDRA HADIYANTA


11/04/2016 31/03/2017

KANTOR CABANG : R00- KANTOR CABANG BANJARMASIN


IKS


1 1400000000227 BLUD RUMAH SAKIT HADJI BOEJASIN

JL H BOEJASIN NO 68 PELAIHARI 22009 PER/05/042015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

2 1500000000151 RS KHUSUS BEDAH BANJARMASIN SIAGA

JL JEND AHMAD YANI KM 4.5 NO 73 3267352 PT SUTIKSNA PER/02/022015 RS.TRAUMA CENTRE

02/02/2015 29/02/2016

3 7-2797750137RSJ SAMBANG LIHUM BANJARMASIN

JL. GUBENRNUR SYARKAWI KM 3,9 GAMBUT KAB. BANJAR 00000 H.IBG DHARMA PUTRA PER/03/032016

RS.TRAUMA CENTRE 11/04/2016 17/03/2017

4 1500000000216 RSUD ANSARI SALEH JL. BRIGJEND H. HASAN BASRI NO 1 6710000 PER/03/022015RS.TRAUMA CENTRE 03/02/2015 31/01/2016

5 7-3955358130 RSUD BALANGAN JL LINGKAR TIMUR KM 1.7 PERINGIN 71614 DRG SUDIRMAN, MM PER/12/062016RS.TRAUMA CENTRE

29/06/2016 31/05/2017

6 7-3406058853 RSUD BANJARBARU JL PALANG MERAH 2 BANJARBARU 70713 05114772380

DR. HJ. ENDAH LABATI SILAPURNA, MH. KES


18/05/2016 31/03/2017


Periode : 01/01/2015 s/d 31/10/2016


394 / 44607-11-201606:23:31



IKS


7 7-4908547588 RSUD BRIGJEND H HASAN BASRY

JL JENDERAL SUDIRMAN HAMALAU SUNGAI RAYA 71211 DR HJ RASYIDAH PER/15/082016 RS.TRAUMA

CENTRE 22/09/2016 31/07/2017

8 1500000000949 RSUD BRIGJEND H HASAN BASRY KANDANGAN JL JEND SUDIRMAN NO 29 KANDANGAN 21653 PER/09/052015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

9 1500000000950 RSUD DATU SANGGUL RANTAU

JL. BRIGJEND H HASAN BASRY KM 1 RANTAU


01/06/2015 31/05/2016

10 1500000000950 RSUD DATU SANGGUL RANTAU

JL. BRIGJEND H HASAN BASRY KM 1 RANTAU


26/09/2016 31/08/2017

11 7-4839680013 RSUD DR H MOCH ANSARI SALEH JL BRIGJEND H HASAN BASRI NO 1 BJM 70125

DR. DR. IZAAK ZOELKARNAIN AKBAR, SPOT


12 7-4217815733RSUD H ABDUL AZIZ MARABAHAN

JL JENDRAL SUDIRMAN NO 10 MARABAHAN 70511

DR LUSIA MIENHARNI, MKES PER/14/072016

RS.TRAUMA CENTRE 01/08/2016 17/07/2017

13 1500000000020 RSUD H ABDUL AZIZ MARABAHAN

JL JEND. SUDIRMAN NO 10 RT 13 RW 01 MARABAHAN


01/01/2015 31/12/2015

14 7-3954807859 RSUD H BADARUDDIN TANJUNG

JL JAKSA AGUNG SUPRAPTO TANJUNG 71512 DR H TAUFIQURRAHMANHAMDIE


25/10/2016 31/05/2017

15 7-3971293353RSUD H BOEJASIN PELAIHARI JL H BOEJASIN NO 68 PELAIHARI 70812 DR H EDY WAHYUDI PER/10/062016

RS.TRAUMA CENTRE 29/06/2016 31/05/2017

16 7-4895837893RSUD H DAMANHURI BARABAI JL MURAKATA NO 4 BARABAI 71312

PEMDA HULU SUNGAI TENGAH PER/20/092016

RS.TRAUMA CENTRE 21/09/2016 31/08/2017

17 1400000000489RSUD PAMBALAH BATUNG AMUNTAI

JL JEND BASUKI RAHMAT NO 1 AMUNTAI 61401 PER/16/082016RS.TRAUMA CENTRE

26/09/2016 31/08/2017

18 7-4148373163 RSUD RATU ZALECHA MARTAPURA

JL MENTERI EMPAT MARTAPURA 70611 DRG YASNA KHAIRINA, MM


25/07/2016 31/03/2017


Periode : 01/01/2015 s/d 31/10/2016


395 / 44607-11-201606:23:31



IKS


19 7-2464169583 RSUD ULIN BANJARMASIN JL. A. YANI NO.43 BANJARMASIN 70233 33257472 DR. HJ. SUCIATI M. KES PER/02/032016 RS.TRAUMA CENTRE 10/03/2016 02/03/2017

20 1500000000765RUMAH SAKIT BHAYANGKARA BANJARMASIN

JL. A. YANI KM 3,5 BANJARMASIN 3256528 PER/07/052015 RS.TRAUMA CENTRE 06/05/2015 31/05/2017

21 1500000001493 RUMAH SAKIT SARI MULIA BANJARMASIN

JL PANGERAN ANTASARI NO 139 BANJARMASIN


01/06/2015 31/05/2016

22 1400000000226 RUMAH SAKIT SUAKA INSAN BANJARMASIN

JL H ZAFRI ZAMZAM NO 60 BANJARMASIN 3353335 YAYASAN SUAKA INSAN PER/11/062015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016

KANTOR CABANG : R01- KANTOR CABANG SAMPIT


IKS


1 1500000001648 PUSKESMAS BAAMANG I PER/02/072016 RS.TRAUMA CENTRE

14/09/2016 30/06/2017

2 1500000001648 PUSKESMAS BAAMANG I PER/02/062015RS.TRAUMA CENTRE 01/07/2015 30/06/2016

3 1500000001650 PUSKESMAS BAAMANG II PER/02/062015RS.TRAUMA CENTRE 01/07/2015 30/06/2016

4 1500000001650 PUSKESMAS BAAMANG II PER/02/072016RS.TRAUMA CENTRE

14/09/2016 30/06/2017

5 1500000001643 PUSKESMAS BAGENDANG PER/02/072016 RS.TRAUMA CENTRE

14/09/2016 30/06/2017


Periode : 01/01/2015 s/d 31/10/2016


396 / 44607-11-201606:23:31



IKS


6 1500000001643 PUSKESMAS BAGENDANG PER/02/062015 RS.TRAUMA CENTRE 01/07/2015 30/06/2016

7 1500000001634 PUSKESMAS BAPINANG PER/02/062015 RS.TRAUMA CENTRE 01/07/2015 30/06/2016

8 1500000001634 PUSKESMAS BAPINANG PER/02/072016 RS.TRAUMA CENTRE

14/09/2016 30/06/2017

9 1500000001657 PUSKESMAS CEMPAKA MULIA


14/09/2016 30/06/2017

10 1500000001657 PUSKESMAS CEMPAKA MULIA PER/02/062015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

11 1500000001645 PUSKESMAS KETAPANG I PER/02/062015RS.TRAUMA CENTRE 01/07/2015 30/06/2016

12 1500000001645 PUSKESMAS KETAPANG I PER/02/072016 RS.TRAUMA CENTRE

25/10/2016 30/06/2017

13 1500000001646 PUSKESMAS KETAPANG II PER/02/072016 RS.TRAUMA CENTRE

14/09/2016 30/06/2017

14 1500000001646 PUSKESMAS KETAPANG II PER/02/062015RS.TRAUMA CENTRE 01/07/2015 30/06/2016

15 1500000001656 PUSKESMAS KOTA BESI PER/02/072016RS.TRAUMA CENTRE 14/09/2016 30/06/2017

16 1500000001656 PUSKESMAS KOTA BESI PER/02/062015RS.TRAUMA CENTRE

01/07/2015 30/06/2016

17 1500000001661 PUSKESMAS KUALA KUAYAN


01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


397 / 44607-11-201606:23:31



IKS


18 1500000001661 PUSKESMAS KUALA KUAYAN PER/02/072016 RS.TRAUMA

CENTRE 14/09/2016 30/06/2017

19 1500000001654 PUSKESMAS MENTAYA SEBERANG PER/02/072016 RS.TRAUMA

CENTRE 25/10/2016 30/06/2017

20 1500000001654 PUSKESMAS MENTAYA SEBERANG


01/07/2015 30/06/2016

21 1500000001659 PUSKESMAS PARENGGEAN I PER/02/072016 RS.TRAUMA CENTRE

14/09/2016 30/06/2017

22 1500000001659 PUSKESMAS PARENGGEAN I PER/02/062015 RS.TRAUMA CENTRE 01/07/2015 30/06/2016

23 1500000001660PUSKESMAS PARENGGEAN II PER/02/062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

24 1500000001660 PUSKESMAS PARENGGEAN II


14/09/2016 30/06/2017

25 1500000001653 PUSKESMAS PASIR PUTIH PER/02/072016 RS.TRAUMA CENTRE

14/09/2016 30/06/2017

26 1500000001653 PUSKESMAS PASIR PUTIH PER/02/062015RS.TRAUMA CENTRE 01/07/2015 30/06/2016

27 1500000001658 PUSKESMAS PUNDU PER/02/062015RS.TRAUMA CENTRE 01/07/2015 30/06/2016

28 1500000001658 PUSKESMAS PUNDU PER/02/072016RS.TRAUMA CENTRE

14/09/2016 30/06/2017

29 1500000001642 PUSKESMAS SAMUDA PER/02/062015 RS.TRAUMA CENTRE

01/07/2015 30/06/2016


Periode : 01/01/2015 s/d 31/10/2016


398 / 44607-11-201606:23:31



IKS


30 1500000001642 PUSKESMAS SAMUDA PER/02/072016 RS.TRAUMA CENTRE 14/09/2016 30/06/2017

31 1500000001655 PUSKESMAS SEBABI PER/02/062015 RS.TRAUMA CENTRE 01/07/2015 30/06/2016

32 1500000001655 PUSKESMAS SEBABI PER/02/072016 RS.TRAUMA CENTRE

14/09/2016 30/06/2017

33 1500000001663 PUSKESMAS TUMBANG KALANG


14/09/2016 30/06/2017

34 1500000001663 PUSKESMAS TUMBANG KALANG PER/02/062015 RS.TRAUMA

CENTRE 01/07/2015 30/06/2016

35 1500000001664PUSKESMAS TUMBANG PENYAHUAN PER/02/072016

RS.TRAUMA CENTRE 14/09/2016 30/06/2017

36 1500000001664 PUSKESMAS TUMBANG PENYAHUAN


01/07/2015 30/06/2016

37 1500000001662 PUSKESMAS TUMBANG SANGAI


14/09/2016 30/06/2017

38 1500000001662PUSKESMAS TUMBANG SANGAI PER/02/062015

RS.TRAUMA CENTRE 01/07/2015 30/06/2016

39 1500000001635PUSKESMAS UJUNG PANDARAN PER/02/072016

RS.TRAUMA CENTRE 14/09/2016 30/06/2017

40 1500000001635PUSKESMAS UJUNG PANDARAN


01/07/2015 30/06/2016

41 1400000000145 RSUD DR MURJANI SAMPIT JL HM ARSYAD NO 65 25052 PEMKAB KOTIM PER/01/012016 RS.TRAUMA CENTRE

13/06/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


399 / 44607-11-201606:23:31



IKS


42 1400000000145 RSUD DR MURJANI SAMPIT JL HM ARSYAD NO 65 25052 PEMKAB KOTIM PER/05/122014 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

43 1400000000146 RSUD KUALA PEMBUANG JL. A. YANI NO.30 KUALA PEMBUANG 21017 RSUD KUALA PEMBUANG PER/06/122014 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

44 1500000000116 RUMAH SAKIT DAERAH HANAU

JL SAMPIT-PANGKALANBUN KM 142 PEMBUANG HULU


01/07/2016 01/01/2018

45 1500000000116 RUMAH SAKIT DAERAH HANAU

JL SAMPIT-PANGKALANBUN KM 142 PEMBUANG HULU


01/01/2015 31/12/2015

KANTOR CABANG : R02- KANTOR CABANG KOTABARU


IKS


1 7-4459341956KLINIK CENTRAL MINAMAS PLANTATION (AREA PAMUKAN)

DESA BINTURUNG RT.015,RW.004 KEC.PAMUKAN UTARA KOTABARU KALSEL

72169 PT. LANGGENG MUARAMAKMUR


25/08/2016 31/12/2017

2 7-4454830783 KLINIK HARAPAN BERSAMA DESA BEKAMBIT KEC.P. LAUT TIMUR 72152PT. BERSAMA SEJAHTERA SAKTI PER/03/072016

RS.TRAUMA CENTRE 25/08/2016 31/12/2017

3 7-4459161305 KLINIK MATALOK ESTATEJALAN ALTERNATIF CPO CHC 30 BEPARA PAMUKAN UTARA 72169 PT. LAGUNA MANDIRI PER/05/072016

RS.TRAUMA CENTRE 25/08/2016 31/12/2017

4 7-4454052313 KLINIK SENTRAL ASE DESA BAYANSARI KEC. ANGSANA 72275PT. LADANG RUMPUN SUBUR ABADI


25/08/2016 31/12/2017

5 7-3934298084

RSUD DR.AH.ANDI ABDURRAHMAN NOOR KABUPATEN TANAH BUMBU

JL.H.AMIN KM.10 RT.03 DESA SEPUNGGUR KEC.BATULICIN

72211 PEMKAB TANAH BUMBU PER/01/052016 RS.TRAUMA CENTRE

24/06/2016 01/05/2018


Periode : 01/01/2015 s/d 31/10/2016


400 / 44607-11-201606:23:31



IKS


6 1400000000374 RSUD H ABDURRAHMAN NOOR TANAH BUMBU KOMP PERKANTORAN TANAH BUMBU 71067 PEMKAB TANAH BUMBU PER/02/032015 RS.TRAUMA

CENTRE 01/04/2015 28/02/2016

7 1500000000845 RUMAH SAKIT UMUM DAERAH KOTABARU JL.H.HASAN BASRI NO.57 22945 PER/04/052015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2015

8 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 1500000001713BLK DINAS SOSIAL DAN TENAGA KERJA KOTA PALANGKARAYA

JL TJILIK RIWUT KM 6.5DINAS SOSIAL DAN TENAGA KERJA KOTA PALANGKARAYA


11/05/2015 11/06/2016

2 1400000000279 BLUD RUMAH SAKIT UMUM DAERAH KUALA KURUN

JL A YANI NO 43 KUALA KURUN 31459 DAERAH KUALA KURUN PER/18/082015 RS.TRAUMA CENTRE

01/08/2015 01/08/2016

3 1500000000632KLINIK INSANI MUARA TEWEH

JL.JEND.SUDIRMAN NO.09 RT.28 MUARA TEWEH 49418222 HERIANSYAH PER/015/042015

RS.TRAUMA CENTRE 07/04/2015 07/04/2017

4 1500000000540NON BLUD RSUD KAB. PULANG PISAU JL. WAD DUHA KOMP. PERKANTORAN DIREKTUR PER/04/062016

RS.TRAUMA CENTRE 25/10/2016 13/06/2018

5 1500000000740RS. PKU MUHAMMADIYAH PALANGKARAYA

JL.RTA. MILONO KM.2.5 3239444 DR.SUYANTO, SP.PD PER/06/042015RS.TRAUMA CENTRE

22/04/2015 22/05/2017

6 7-2907310053 RSUD DR DORIS SYLVANUS JL TAMBUN BUNGAI NO 04 73111 PEMERINTAH DAERAH PER / 11 /022016 RS.TRAUMA CENTRE

13/04/2016 26/02/2017


Periode : 01/01/2015 s/d 31/10/2016


401 / 44607-11-201606:23:31



IKS


7 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

8 1400000000137 RSUD JARAGA SASAMEH JL PATIANON NO 6 BUNTOK 21021 RSUD BUNTOK PER/07/042015 RS.TRAUMA CENTRE 30/04/2015 27/04/2017

9 1500000001397 RSUD. PURUK CAHU JL. A. YANI NO.497 PURUK CAHU 31300 PER/14/062015 RS.TRAUMA CENTRE

11/06/2015 11/06/2017

10 1500000001396 RSUD. TAMIANG LAYANG JL.NANSARUNAI TAMIANG LAYANG NO.62 2091235 ANDA KRISELINA MKES PER/17/062015 RS.TRAUMA CENTRE

11/06/2015 11/07/2017

11 1300000000046 RUMAH SAKIT BHAYANGKARA TK IV JL JENDERAL A YANI NO 22 3281553 POLDA KAL TENG PER/13/032016 RS.TRAUMA

CENTRE 13/04/2016 28/02/2017

12 1500000001375RUMAH SAKIT TK IV. 12.07.03 PALANGKA (RUMKIT TNI AD)

JL DIPONEGEORO NO 55 PALANGKA RAYADR. I NYOMAN INDRAWAN SO.PD PER/12/052015

RS.TRAUMA CENTRE 25/05/2015 25/05/2017

13 7-2201647033UPT PUSKESMAS TANGKILING PALANGKARAYA

JL TJILIK RIWUT KM 34 KEL TANGKILING KEC BUKIT BATU

73221 UPT PUSKESMAS TANGKILING


24/02/2016 22/07/2016

KANTOR CABANG : R04- KANTOR CABANG PANGKALAN BUN


IKS


1 7-1706946523 PUSKESMAS KUMAI JL PEMUDA KECAMATAN KUMAI 74181 DR ABIMAYU PER/03/012016RS.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


29/01/2016 18/01/2017


Periode : 01/01/2015 s/d 31/10/2016


402 / 44607-11-201606:23:31



IKS


3 1400000000346 RSUD IMANUDDIN PANGKALAN BUN JLN SUTAN SYAHRIR PANGKALAN BUN PER/04/032016 RS.TRAUMA

CENTRE 09/08/2016 31/03/2017

4 1400000000346 RSUD IMANUDDIN PANGKALAN BUN JLN SUTAN SYAHRIR PANGKALAN BUN PER/03/042015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

5 1500000000084 RSUD LAMANDAU NANGA BULIK KM 04 KABUPATEN LAMANDAU


14/09/2016 31/08/2017

6 1400000000380 RSUD SUKAMARA JALAN TJILIK RIWUT KM 5,5 SUKAMARA PER/14/092016 RS.TRAUMA CENTRE

14/09/2016 06/09/2017

KANTOR CABANG : S00- KANTOR CABANG BALIKPAPAN


IKS


1 1500000000552 POLIKLINIK IBNU SINA BALIKPAPAN

JL.JEND.A.YANI NO.252 KEL.MUARA RAPAK 7091900 DR.HADI YUNIARKO PER/16/042016 RS.TRAUMA CENTRE

26/04/2016 31/03/2017

2 1500000000552POLIKLINIK IBNU SINA BALIKPAPAN JL.JEND.A.YANI NO.252 KEL.MUARA RAPAK 7091900 DR.HADI YUNIARKO PER/16/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

3 1500000001318PT.MITRA SEHAT UTAMA (KLINIK MITRA SEHAT)

JL.SOEKARO HATTA NO.01 RT.82 KEL.BATU AMPAR KEC.BALIKPAPAN UTARA 441362 DEBBY TANDY, SE PER/19/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

4 7-1030679543 PUKESMAS BATU KAJANG JL.NEGARA RT.09 KE.BATU SOPANG 76252I DEWA MADE SUDARSANA


21/12/2015 07/09/2016

5 1500000001423 PUSKESMAS BARU ILIR JL. AL-FALAH RT.33 NO.02, KEC. BALIKPAPAN BARAT


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


403 / 44607-11-201606:23:31



IKS


6 1500000001423 PUSKESMAS BARU ILIR JL. AL-FALAH RT.33 NO.02, KEC. BALIKPAPAN BARAT PER/19/052016 RS.TRAUMA

CENTRE 08/06/2016 31/05/2017

7 1500000001421 PUSKESMAS BARU TENGAH JL. LETJEN SOEPRAPTO RT.26 NO.30, KEC. BALIKPAPAN BARAT PER/46/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

8 1500000001421 PUSKESMAS BARU TENGAH JL. LETJEN SOEPRAPTO RT.26 NO.30, KEC. BALIKPAPAN BARAT


09/06/2016 31/05/2017

9 1500000001427 PUSKESMAS BARU ULU JL. WOLTER MONGINSIDI RT.47 NO.85, KEC. BALIKPAPAN BARAT


09/06/2016 31/05/2017

10 1500000001427 PUSKESMAS BARU ULU JL. WOLTER MONGINSIDI RT.47 NO.85, KEC. BALIKPAPAN BARAT PER/41/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

11 1500000001437 PUSKESMAS BATU AMPARJL. A.WAHAB SYACHRANI RT.10, KEC. BALIKPAPAN UTARA PER/33/062016

RS.TRAUMA CENTRE 09/06/2016 31/05/2017

12 1500000001437 PUSKESMAS BATU AMPAR JL. A.WAHAB SYACHRANI RT.10, KEC. BALIKPAPAN UTARA


01/06/2015 31/05/2016

13 1500000001440 PUSKESMAS DAMAI JL. MT HARYONO, KEC. BALIKPAPAN SELATAN


01/06/2015 31/05/2016

14 1500000001440 PUSKESMAS DAMAIJL. MT HARYONO, KEC. BALIKPAPAN SELATAN PER/24/06/2016

RS.TRAUMA CENTRE 08/06/2016 31/05/2017

15 1500000001450PUSKESMAS GUNUNG BAHAGIA

JL. RUHUI RAHAYU RT.15 NO.47, KEC. BALIKPAPAN SELATAN PER/25/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

16 1500000001435PUSKESMAS GUNUNG SAMARINDA

JL. INDRAKILA RT.22, KEC. BALIKPAPAN UTARA


01/06/2015 31/05/2016

17 1500000001435 PUSKESMAS GUNUNG SAMARINDA

JL. INDRAKILA RT.22, KEC. BALIKPAPAN UTARA


09/06/2016 31/05/2017


Periode : 01/01/2015 s/d 31/10/2016


404 / 44607-11-201606:23:31



IKS


18 1500000001431 PUSKESMAS GUNUNG SARI ILIR

JL. MEKAR SARI, KEC. BALIKPAPAN TENGAH PER/37/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

19 1500000001431 PUSKESMAS GUNUNG SARI ILIR

JL. MEKAR SARI, KEC. BALIKPAPAN TENGAH PER/39/06/2016 RS.TRAUMA

CENTRE 09/06/2016 31/05/2017

20 1500000001428 PUSKESMAS GUNUNG SARI ULU

DS. GUNUNGSARI ULU KEC. BALIKPAPAN TENGAH


09/06/2016 31/05/2017

21 1500000001428 PUSKESMAS GUNUNG SARI ULU

DS. GUNUNGSARI ULU KEC. BALIKPAPAN TENGAH


01/06/2015 31/05/2016

22 1500000001432 PUSKESMAS KARANG JATI JL. SULTAN ALAUDDIN RT.01 NO.39, KEC. BALIKPAPAN TENGAH PER/38/062016 RS.TRAUMA

CENTRE 09/06/2016 31/05/2017

23 1500000001432 PUSKESMAS KARANG JATIJL. SULTAN ALAUDDIN RT.01 NO.39, KEC. BALIKPAPAN TENGAH PER/36/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

24 1500000001436 PUSKESMAS KARANG JOANG

JL. SOEKARNO HATTA RT.21 KM.12,5, KEC. BALIKPAPAN UTARA


09/06/2016 31/05/2017

25 1500000001436 PUSKESMAS KARANG JOANG

JL. SOEKARNO HATTA RT.21 KM.12,5, KEC. BALIKPAPAN UTARA


01/06/2015 31/05/2016

26 1500000001430 PUSKESMAS KARANG REJOKEL. KARANG REJO, KEC. BALIKPAPAN TENGAH PER/40/062016

RS.TRAUMA CENTRE 09/06/2016 31/05/2017

27 1500000001430 PUSKESMAS KARANG REJOKEL. KARANG REJO, KEC. BALIKPAPAN TENGAH PER/38/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

28 1500000001426 PUSKESMAS KARIANGAUJL. HASANUDDIN NO.118, KEC. BALIKPAPAN BARAT


09/06/2016 31/05/2017

29 1500000001426 PUSKESMAS KARIANGAU JL. HASANUDDIN NO.118, KEC. BALIKPAPAN BARAT


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


405 / 44607-11-201606:23:31



IKS


30 7-1039247964 PUSKESMAS KAYUNGO JL.ALAS DS.LONG GELANG , KEC. LONG IKIS 76282 I DEWA MADE

SUDARSANA PER/15/092015 RS.TRAUMA CENTRE 18/12/2015 07/09/2016

31 7-1036615116 PUSKESMAS KERANG JL.HAUR KUNING DS.KERANG , KEC. BATU ENGAU 76261 I DEWA MADE


32 1500000001447 PUSKESMAS KLANDASAN ILIR

JL. JEND. SUDIRMAN NO.118, KEC. BALIKPAPAN SELATAN


01/06/2015 31/05/2016

33 1500000001447 PUSKESMAS KLANDASAN ILIR

JL. JEND. SUDIRMAN NO.118, KEC. BALIKPAPAN SELATAN


08/06/2016 31/05/2017

34 7-1039186643 PUSKESMAS KRAYAN DS.KRAYAN SENTOSA , KEC.LONG IKIS 76282 I DEWA MADE SUDARSANA PER/14/092015 RS.TRAUMA

CENTRE 18/12/2015 07/09/2016

35 7-1038939360 PUSKESMAS KUAROJL.JEND.A.YANI RT.018 RW.005 KEL.KUARO , KEC. KUARO 76281

I DEWA MADE SUDARSANA PER/11/092015

RS.TRAUMA CENTRE 18/12/2015 07/09/2016

36 1500000001441 PUSKESMAS LAMARU JL. PUSKESMAS, LAMARU, KEC. BALIKPAPAN TIMUR


01/06/2015 31/05/2016

37 1500000001441 PUSKESMAS LAMARU JL. PUSKESMAS, LAMARU, KEC. BALIKPAPAN TIMUR


08/06/2016 31/05/2017

38 7-1039031521 PUSKESMAS LOLO JL.SAWIT DS.KALUANG LOLO, KEC.KUARO 76281I DEWA MADE SUDARSANA PER/12/092015

RS.TRAUMA CENTRE 18/12/2015 07/09/2016

39 7-1039093892 PUSKESMAS LONG IKIS JL.NEGARA KM.82 , KEC.LONG IKIS 76282I DEWA MADE SUDARSANA PER/13/092015

RS.TRAUMA CENTRE 18/12/2015 07/09/2016

40 7-1039387686 PUSKESMAS LONG KALIJL.PROPINSI KM 63 KADEMAN , KEC.LONG KALI

76283I DEWA MADE SUDARSANA


18/12/2015 07/09/2016

41 1500000001451 PUSKESMAS MANGGAR JL. MULAWARMAN RT.07, KEC. BALIKPAPAN TIMUR


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


406 / 44607-11-201606:23:31



IKS


42 1500000001451 PUSKESMAS MANGGAR JL. MULAWARMAN RT.07, KEC. BALIKPAPAN TIMUR PER/29/06/2016 RS.TRAUMA

CENTRE 08/06/2016 31/05/2017

43 1500000001438 PUSKESMAS MANGGAR BARU JL. PJHI RT.21, KEC. BALIKPAPAN TIMUR PER/30/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

44 1500000001438 PUSKESMAS MANGGAR BARU

JL. PJHI RT.21, KEC. BALIKPAPAN TIMUR PER/32/062016 RS.TRAUMA CENTRE

08/06/2016 31/05/2017

45 1500000001420 PUSKESMAS MARGASARI JL. PANDAN BARAT RT.15 NO.26, KEC. BALIKPAPAN BARAT


01/06/2015 31/05/2016

46 1500000001420 PUSKESMAS MARGASARI JL. PANDAN BARAT RT.15 NO.26, KEC. BALIKPAPAN BARAT PER/49/062016 RS.TRAUMA

CENTRE 09/06/2016 31/05/2017

47 1500000001422PUSKESMAS MARGO MULYO

JL. GUNUNG IV RT.45 NO.9, KEC. BALIKPAPAN BARAT PER/45/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

48 1500000001422 PUSKESMAS MARGO MULYO

JL. GUNUNG IV RT.45 NO.9, KEC. BALIKPAPAN BARAT


09/06/2016 31/05/2017

49 1500000001433 PUSKESMAS MEKAR SARI JL. POLOKLINIK, KEC. BALIKPAPAN TENGAH


01/06/2015 31/05/2016

50 1500000001433 PUSKESMAS MEKAR SARIJL. POLOKLINIK, KEC. BALIKPAPAN TENGAH PER/37/062016

RS.TRAUMA CENTRE 09/06/2016 31/05/2017

51 7-1039510453 PUSKESMAS MENDIK RT.1 DS.MENDIK , KEC.LONG KALI 76283I DEWA MADE SUDARSANA PER/18/092015

RS.TRAUMA CENTRE 17/12/2015 07/09/2016

52 7-1039309985PUSKESMAS MUARA KOMAM

JL.NEGARA KM 171 NO.40 RT.06 KEL.MUARA KOMAM KEC.MUARA KOMAM



18/12/2015 07/09/2016

53 1500000001434 PUSKESMAS MUARA RAPAK JL. INPRES III RT.24 NO.124A, KEC. BALIKPAPAN UTARA


01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


407 / 44607-11-201606:23:31



IKS


54 1500000001434 PUSKESMAS MUARA RAPAK JL. INPRES III RT.24 NO.124A, KEC. BALIKPAPAN UTARA PER/36/062016 RS.TRAUMA

CENTRE 09/06/2016 31/05/2017

55 7-1035423185 PUSKESMAS MUSER JL.ANWAR NO.43 RT.04 DS.MUSER ,KEC.MUARA SEMU 76252 I DEWA MADE


56 7-1038167538 PUSKESMAS PADANG PENGRAPAT

JL.GAJAH MADA DS.PADANG PENGRAPAT ,KEC.TANAH GROGOT

76251 I DEWA MADE SUDARSANA


18/12/2015 07/09/2016

57 7-1037831466 PUSKESMAS PASIR BELENGKONG

JL.NEGARA DS. PASER BELENGKONG KEC.PASER BELENGKONG



21/12/2015 07/09/2016

58 1500000001448 PUSKESMAS PRAPATAN JL. GUNUNG PASIR NO.1, KEC. BALIKPAPANSELATAN PER/26/062016 RS.TRAUMA

CENTRE 08/06/2016 31/05/2017

59 1500000001448 PUSKESMAS PRAPATANJL. GUNUNG PASIR NO.1, KEC. BALIKPAPANSELATAN PER/24/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

60 1500000001424 PUSKESMAS SEPINGGAN JL. MARSMA ISWAHYUDI NO.456, KEC. BALIKPAPAN SELATAN


01/06/2015 31/05/2016

61 1500000001424 PUSKESMAS SEPINGGAN JL. MARSMA ISWAHYUDI NO.456, KEC. BALIKPAPAN SELATAN


09/06/2016 31/05/2017

62 1500000001425 PUSKESMAS SIDOMULYOJL. SIDOMULYO RT.2 NO.56, KEC. BALIKPAPAN BARAT PER/44/062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

63 1500000001425 PUSKESMAS SIDOMULYOJL. SIDOMULYO RT.2 NO.56, KEC. BALIKPAPAN BARAT PER/46/062016

RS.TRAUMA CENTRE 09/06/2016 31/05/2017

64 7-1037429485PUSKESMAS SUATANG BARU

JL.NEGARA NO.02 DS.SUATANG BARU , KEC.PASER BELENGKONG



21/12/2015 07/09/2016

65 7-1037954297 PUSKESMAS SULILIRAN BARU

JL.NUSA INDAH RT.22DS.SULILIRAN BARU KEC.PASER BELENGKONG



21/12/2015 07/09/2016


Periode : 01/01/2015 s/d 31/10/2016


408 / 44607-11-201606:23:31



IKS


66 1500000001429 PUSKESMAS SUMBER REJO JL. BINA RAGA RT.31 NO.73, KEC. BALIKPAPAN TENGAH PER/39/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

67 1500000001429 PUSKESMAS SUMBER REJO JL. BINA RAGA RT.31 NO.73, KEC. BALIKPAPAN TENGAH PER/41/062016 RS.TRAUMA

CENTRE 09/06/2016 31/05/2017

68 7-1038866109 PUSKESMAS TANAH GROGOT

JL.PANGLIMA SENTIK DS, TANAH GROGOT ,KEC.TANAH GROGOT



18/12/2015 07/09/2016

69 7-1036975507 PUSKESMAS TANJUNG ARU JL.M.DAHRI RT.04 NO.49 DS.TANJUNG KEC.TANJUNG HARAPAN



21/12/2015 07/09/2016

70 1500000001449 PUSKESMAS TELAGA SARI JL. PRAPATAN DALAM NO.1, KEC. BALIKPAPAN SELATAN PER/26/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

71 1500000001449 PUSKESMAS TELAGA SARIJL. PRAPATAN DALAM NO.1, KEC. BALIKPAPAN SELATAN PER/27/062016

RS.TRAUMA CENTRE 08/06/2016 31/05/2017

72 1500000001439 PUSKESMAS TERITIP JL. PENDIDIKAN RT.18, KEC. BALIKPAPAN TIMUR


08/06/2016 31/05/2017

73 1500000001439 PUSKESMAS TERITIP JL. PENDIDIKAN RT.18, KEC. BALIKPAPAN TIMUR


01/06/2015 31/05/2016

74 1400000000064 RS BALIKPAPAN BARUJL MT HARYONO KOMPLEK BALIKPAPAN BARU BLOK A3 A NO 7-9 KALTIM 877330 DR M DANARTO, M MED PER/04/022015

RS.TRAUMA CENTRE 01/03/2015 29/02/2016

75 1400000000064 RS BALIKPAPAN BARUJL MT HARYONO KOMPLEK BALIKPAPAN BARU BLOK A3 A NO 7-9 KALTIM 877330 DR M DANARTO, M MED PER/09/04/2016

RS.TRAUMA CENTRE 26/04/2016 28/02/2017

76 1300000000049 RS DR R. HARDJANTOJL TANJUNG PURA NO. IV NO.41 RT.25 KEL.KLANDASAN ULU

423409DR.NANA SARNADI,SP.OG


18/05/2016 31/10/2016

77 1400000000045 RS PERTAMINA BALIKPAPAN

JL JEND SUDIRMAN NO I BALIKPAPAN 734020 PT PERTAMINA BINA MEDIKA


19/09/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


409 / 44607-11-201606:23:31



IKS


78 1400000000045 RS PERTAMINA BALIKPAPAN JL JEND SUDIRMAN NO I BALIKPAPAN 734020 PT PERTAMINA BINA


79 1400000000065 RS RESTU IBU BALIKPAPAN JL JEND A YANI NO 12 BALIKPAPAN 427342 PT RESTU IBU BALIKPAPAN PER/10/042016 RS.TRAUMA

CENTRE 08/06/2016 28/02/2017

80 1400000000065 RS RESTU IBU BALIKPAPAN JL JEND A YANI NO 12 BALIKPAPAN 427342 PT RESTU IBU BALIKPAPAN


01/03/2015 28/02/2016

81 7-3289201063 RSUD DR.KANUJOSO DJATIWIBOWO BALIKPAPAN

JL.MT.HARYONO NO.656, BALIKPAPAN 76125DR.EDY ISKANDAR,SP.PD.,FINASIM.,MARS


13/05/2016 01/05/2017

82 1500000000729 RSUD KOTA BALIKPAPAN JL.MAYJEND SUTOYO RT.01 KEL.GUNUNG SARI ULU KEC.BALIKPAPAN TENGAH DRG.DYAH MURYANI PER/13/042016 RS.TRAUMA

CENTRE 11/05/2016 31/03/2017

83 1500000000729 RSUD KOTA BALIKPAPANJL.MAYJEND SUTOYO RT.01 KEL.GUNUNG SARI ULU KEC.BALIKPAPAN TENGAH DRG.DYAH MURYANI PER/15/042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

84 1500000000184 RSUD PENAJAM PASER UTARA

JL.PROPINSI KM.09 PENAJAM PASER UTARAKALTIM

7211361 DR.JANSJE GRACE MAKISURAT


11/05/2016 05/02/2017

85 1500000000184 RSUD PENAJAM PASER UTARA

JL.PROPINSI KM.09 PENAJAM PASER UTARAKALTIM

7211361 DR.JANSJE GRACE MAKISURAT


05/02/2015 05/02/2016

86 1500000000188RUMAH SAKIT BHAYANGKARA BALIKPAPAN

JL.JEND.SUDIRMAN NO.14 BALIKPAPAN 421261DR.WILDAN DJAYA SOEKMARA,SP.B,FINACS PER/06/012015

RS.TRAUMA CENTRE 01/02/2015 28/02/2016

87 1500000000188RUMAH SAKIT BHAYANGKARA BALIKPAPAN

JL.JEND.SUDIRMAN NO.14 BALIKPAPAN 421261DR.WILDAN DJAYA SOEKMARA,SP.B,FINACS PER/12/042016

RS.TRAUMA CENTRE 11/05/2016 28/02/2017

88 1500000001325RUMAH SAKIT TINGKAT IV LANUD BALIKPAPAN

JL.MARSMA ISWAHYUDI RT.31 KEL.SEPINGGAN BARU KEC.BALIKPAPAN SELATAN

761141DR.MARKUS KABAN, SP.PK


01/06/2015 31/05/2016

89 1500000001325 RUMAH SAKIT TINGKAT IV LANUD BALIKPAPAN

JL.MARSMA ISWAHYUDI RT.31 KEL.SEPINGGAN BARU KEC.BALIKPAPAN SELATAN

761141 DR.MARKUS KABAN, SP.PK


08/06/2016 31/05/2017


Periode : 01/01/2015 s/d 31/10/2016


410 / 44607-11-201606:23:31



IKS


90 1400000000047RUMAH SAKIT UMUM DAERAH PANGLIMA SEBAYA

JL KESUMA BANGSA KM 5 TANA PASER 24563 PER/14/042016 RS.TRAUMA CENTRE 25/10/2016 31/12/2017

91 1400000000047RUMAH SAKIT UMUM DAERAH PANGLIMA SEBAYA

JL KESUMA BANGSA KM 5 TANA PASER 24563 PER/05/022015 RS.TRAUMA CENTRE 01/03/2015 28/02/2016

92 1300000000048 SILOAM HOSPITALS JL MT. HARYONO NO. 9 BALIKPAPAN 7206509 PT BALIKPAPAN DAMAI HUSADA


01/01/2015 31/12/2015

93 1300000000048 SILOAM HOSPITALS JL MT. HARYONO NO. 9 BALIKPAPAN 7206509 PT BALIKPAPAN DAMAI HUSADA


18/05/2016 31/12/2016

94 1500000001034UPTD BALAI LATIHAN KERJA INDUSTRI BALIKPAPAN

JL.SEPINGGAN BARU NO.31 BALIKPAPAN 762681 PER/50/062016 RS.TRAUMA CENTRE 21/10/2016 31/12/2017

95 1500000001034UPTD BALAI LATIHAN KERJA INDUSTRI BALIKPAPAN

JL.SEPINGGAN BARU NO.31 BALIKPAPAN 762681 PER/01/012015RS.TRAUMA CENTRE 01/05/2015 30/04/2016

KANTOR CABANG : S01- KANTOR CABANG SAMARINDA


IKS


1 1500000001816BALAI LATIHAN KERJA INDUSTRI SAMARINDA

JALAN UNTUNG SUROPATI NO.43, SUNGAI KUNJANG, KOTA SAMARINDA, KALIMANTAN TIMU

75126 272421 PER/04/062015RS.TRAUMA CENTRE 04/06/2015 04/06/2016

2 1500000000915 KLINIK SANTO YOSEFJL OLAH BEBAYA RT 10 LINGGANG BIGUNG

021/K.ST.Y/IV/2015

RS.TRAUMA CENTRE

01/04/2015 31/03/2016

3 7-1380214421 PUKESMAS BANTUAS JL BANTUAS PALARAN 75241 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

12/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


411 / 44607-11-201606:23:31



IKS


4 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

5 7-1464311570 PUSKESMAS BAQA JL BAQA SAMARINDA SEBERANG 75131 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE 20/01/2016 31/12/2016

6 7-1356917662 PUSKESMAS BENGKURING BENGKURING 75118 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

11/01/2016 31/12/2016

7 7-1380408843 PUSKESMAS BUKUAN JL BUKUAN PALARAN 75241 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

8 7-1464600433 PUSKESMAS HARAPAN BARU

JL HARAPAN BARU SAMARINDA SEBERANG 75131 PEMERINTAH PKS/02/12.2015 RS.TRAUMA

CENTRE 20/01/2016 31/12/2016

9 7-1359826423 PUSKESMAS JUANDA JL IR JUANDA SAMARINDA ULU 75122 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE 11/01/2016 31/12/2016

10 7-1507208803 PUSKESMAS KARANG ASAMSAMARINDA

JL KARANG ASAM 75125 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

11 7-1464440551 PUSKESMAS LEMPAKE JL LEMPAKE SAMARINDA UTARA 75118 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

12 7-1466746238 PUSKESMAS LOA BAKUNG JL LOA BAKUNG SUNGAI KUNJANG 75125 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE 20/01/2016 31/12/2016

13 7-1380502014 PUSKESMAS MAKROMAN JL MAKROMAN PALARAN 75241 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE 12/01/2016 31/12/2016

14 7-1464657234PUSKESMAS MANGKUPALAS

JL MANGKUPALAS SAMARINDA SEBERANG 75131 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE

20/01/2016 31/12/2016

15 7-1464111057 PUSKESMAS PALARAN JL PALARAN 75241 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

20/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


412 / 44607-11-201606:23:31



IKS


16 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

17 7-1463967676 PUSKESMAS REMAJA JL REMAJA SUNGAI PINANG 75117 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE 20/01/2016 31/12/2016

18 7-1464167298 PUSKESMAS SAMBUTAN JL SAMBUTAN 75114 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

19 7-1461318105 PUSKESMAS SEGIRI JL SEGIRI SAMARINDA KOT 75111 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

20 7-1380543865 PUSKESMAS SEMPAJA SEMPAJA SAMARINDA UTARA 75118 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE 12/01/2016 31/12/2016

21 7-1465607297 PUSKESMAS SIDOMULYO JL SIDOMULYO SAMARINDA ILIR 75114 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE 20/01/2016 31/12/2016

22 7-1464546252 PUSKESMAS SUNGAI KAPIH JL SUNGAI KAPIH SAMBUTAN 75114 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

20/01/2016 31/12/2016

23 7-1378835889 PUSKESMAS SUNGAI SIRING KELURAHAN SUNGAI SIRING SAMARINDA 75118 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

12/01/2016 31/12/2016

24 7-1380635626 PUSKESMAS TEMINDUNG JL TEMINDUNG SAMARINDA UTARA 75118 PEMERINTAH PKS/02/12.2015RS.TRAUMA CENTRE 12/01/2016 31/12/2016

25 1500000000941PUSKESMAS TRAUMA CENTRE

JL CIPTO MANGUNKUSUMO KEL SENGKOTEK KEC LOA JANAN ILIR PKS/02/12.2015

RS.TRAUMA CENTRE 11/04/2016 31/12/2016

26 1500000000941PUSKESMAS TRAUMA CENTRE

JL CIPTO MANGUNKUSUMO KEL SENGKOTEK KEC LOA JANAN ILIR

PKS/01/042015RS.TRAUMA CENTRE

01/04/2015 31/03/2016

27 7-1380777307 PUSKESMAS WONOREJO KELURAHAN WONOREJO 75125 PEMERINTAH PKS/02/12.2015 RS.TRAUMA CENTRE

12/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


413 / 44607-11-201606:23:31



IKS


28 7-4905725233 RS DIRGAHAYU JL GUNUNG MERBABU NO 62 75122 0541742161 DR YOHANES LIBUT 01/PKS/TC/0920

16RS.TRAUMA CENTRE 22/09/2016 31/12/2016

29 1500000001242 RS SAMARINDA MEDIKA CITRA JL KADRIE OENING NO 81 RT 35 AIR HITAM PKS/02/04/2015 RS.TRAUMA

CENTRE 01/04/2015 31/03/2016

30 1400000000160 RS. ISLAM SAMARINDA JL. GURAMI NO.18 741510 DR. SYAFARDI IBRAHIM PKS/01/052015 RS.TRAUMA CENTRE

11/04/2016 30/04/2016

31 1400000000160 RS. ISLAM SAMARINDA JL. GURAMI NO.18 741510 DR. SYAFARDI IBRAHIM PER/01/07.2016 RS.TRAUMA CENTRE

01/08/2016 30/04/2017

32 7-3057671463 RSJD ATMA HUSADA MAHAKAM JL KAKAP NO 23 KOTA SAMARINDA 75114 PEMERINTAH PKS/01/042016 RS.TRAUMA

CENTRE 25/04/2016 31/03/2017

33 1500000000320RSUD ABDUL WAHAB SJAHRANI JL PMI KOTA SAMARINDA PKS/01/032016

RS.TRAUMA CENTRE 18/03/2016 31/12/2016

34 1500000000320 RSUD ABDUL WAHAB SJAHRANI

JL PMI KOTA SAMARINDA PKS/01/012015 RS.TRAUMA CENTRE

02/01/2015 31/12/2015

35 1400000000413 RSUD HARAPAN INSAN SENDAWAR

JL MAWAR KEC. SEKOLAQ DARAT 4044001 PKS/01/112015 RS.TRAUMA CENTRE

11/04/2016 31/10/2016

36 7-1356184197 RSUD I.A MOEIS JL H.A M.M RIFADDIN 75131 PEMERINTAH PKS/01/12.2015RS.TRAUMA CENTRE 11/01/2016 31/12/2016

37 1400000000519RSUD PARIKESIT TENGGARONG JL. IMAM BONJOL NO.3 TENGGARONG 661015 DR MARTINA PKS/01/012016

RS.TRAUMA CENTRE 10/08/2016 01/01/2017

KANTOR CABANG : S02- KANTOR CABANG TARAKAN


Periode : 01/01/2015 s/d 31/10/2016


414 / 44607-11-201606:23:31



IKS


1 7-4381778493

BLUD RSD DR. H. SOEMARNO SOSROADMODJO KAB BULUNGAN

JL CENDRAWASIH KAB BULUNGAN 77211 PEMDA KAB BULUNGAN PER / 03 / 022016

RS.TRAUMA CENTRE 16/08/2016 01/02/2017

2 1300000000043BLUD RSD. DR. SOEMARNO SOSROADMODJO BULUNGAN

JL. CENDRAWASIH TANJUNG SELOR 21292 PEMKAB BULUNGAN PER/03/022016 RS.TRAUMA CENTRE 10/03/2016 31/01/2017

3 1500000000595 KLINIK CARSA JL. SEBENGKOK TIRAM NO. 3 31457 SITTI RUJIAH, AMD.KEB PER/09/042015RS.TRAUMA CENTRE 21/04/2015 20/04/2016

4 1500000001245 RS PERTAMEDIKA TARAKAN

JL. MULAWARMAN NO. 14 31403 RS PERTAMEDIKA TARAKAN


06/05/2015 05/05/2016

5 1500000001245 RS PERTAMEDIKA TARAKAN JL. MULAWARMAN NO. 14 31403 RS PERTAMEDIKA

TARAKAN PER/11/052015 RS.TRAUMA CENTRE 17/10/2016 31/12/2016

6 1500000000257RSD DR. H. SOEMARNO SOSROADMODJO TANJUNG SELOR PEMKAB BULUNGAN PER/04/022015

RS.TRAUMA CENTRE 01/02/2015 31/01/2016

7 7-4328608673 RSUD KAB MALINAU JL RESPEN TUBU 77554 05532022215

PEMDA KAB MALINAU PER / 06 / 052016

RS.TRAUMA CENTRE

15/08/2016 12/05/2017

8 7-5152165505 RSUD KAB NUNUKAN JL. UJANG FATIMAH SUNGAI FATIMAH KABUPATEN NUNUKAN

77482 PEMDA KAB NUNUKAN PER/14/082015 RS.TRAUMA CENTRE

17/10/2016 31/12/2016

9 7-4577567873 RSUD KOTA TARAKAN JL P IRIAN NO 1 KOTA TARAKAN 77113 055121166 PEMKOT TARAKAN PER/13/082015RS.TRAUMA CENTRE 14/09/2016 31/12/2016

10 1100000000038 RSUD NUNUKAN TC JLN. SEI FATIMAH 24416 PEMKAB NUNUKAN PER/14/082015 RS.TRAUMA CENTRE 01/09/2015 31/08/2016

11 7-582361147 RSUD TARAKAN S02 TC JL P IRIAN NO 1 TARAKAN 00000 PEMPROV KALTIM PER/13/082015RS.TRAUMA CENTRE

30/11/2015 02/08/2016

12 1100000000037 RSUD TARAKAN TC JL.P.IRIAN SKIP 21166 PEMPROV KALTIM 0PER/12/07/2015 RS.TRAUMA CENTRE

01/08/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


415 / 44607-11-201606:23:31


KANTOR CABANG : S03- KANTOR CABANG BONTANG


IKS


1 1500000001250 KLINIK SATELIT 1 RS PKT JL. IMAM BONJOL BONTANG 24800 PT KALTIM MEDIKA UTAMA


27/04/2015 26/04/2017

2 1500000001249 KLINIK SATELIT 2 RS PKT JL. POROS BENGALON - SANGKULIRANG SEPASO TIMUR - BENGALON

PT KALTIM MEDIKA UTAMA PER/13/052015 RS.TRAUMA

CENTRE 27/04/2015 26/04/2017

3 1500000001248 KLINIK SATELIT 3 RS PKT JL. LETJEND S. PARMAN NO 5 BONTANG 23388 PT KALTIM MEDIKA UTAMA PER/14/052015 RS.TRAUMA

CENTRE 27/04/2015 26/04/2017

4 1400000000342 RS PUPUK KALTIM PRIMA SANGATTA JL.YOS SUDARSO I NO.01SANGATTA 24555 RUSTAM EFFENDI PER/16/082015 RS.TRAUMA

CENTRE 28/08/2015 27/08/2016

5 1500000000946 RS. PUPUK KALTIM BONTANG

JL OKSIGEN NO 1 41118 PT KALTIM MEDIKA UTAMA


20/04/2015 19/04/2017

6 1400000000234 RSUD TAMAN HUSADA BONTANG JL. LETJEND S. PARMAN NO. 01 3036990 PER/09/042015 RS.TRAUMA

CENTRE 24/04/2015 23/04/2016

7 1400000000234RSUD TAMAN HUSADA BONTANG JL. LETJEND S. PARMAN NO. 01 3036990 PER/04/052016

RS.TRAUMA CENTRE 15/08/2016 01/05/2018

8 1500000000932RSUD. KUDUNGGA KAB KUTAI TIMUR

JL. SUKARNO HATTA SANGATTA PER/05/062016RS.TRAUMA CENTRE

30/08/2016 05/06/2018

9 1500000000932 RSUD. KUDUNGGA KAB KUTAI TIMUR

JL. SUKARNO HATTA SANGATTA PER/10/042015 RS.TRAUMA CENTRE

24/04/2015 23/04/2016

KANTOR CABANG : S04- KANTOR CABANG BERAU


Periode : 01/01/2015 s/d 31/10/2016


416 / 44607-11-201606:23:31



IKS


1 7-1506142935 PUSKESMAS 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 7-1507943081 PUSKESMAS KAMPUNG BUGIS

JL. H. ISA I KEL. GAYAM KEC. TANJUNG REDEB KAB. BERAU 77311 DINAS KESEHATAN

KABUPATEN BERAU PER/06/122015 RS.TRAUMA CENTRE 20/01/2016 01/12/2016

3 7-1506142939 PUSKESMAS SAMBALIUNG MANGKUBUMI II RT 007 SAMBALIUNG, KAB. BERAU

77371 DINAS KESEHATAN KABUPATEN BERAU


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

5 1400000000141 RSUD ABDUL RIVAI TC JL PULAU PANJANG TG REDEB 21908 PEMDA PER/02/042016 RS.TRAUMA CENTRE 18/05/2016 31/03/2017

KANTOR CABANG : T00- KANTOR CABANG MANADO


IKS


1 1400000000069 DR. FRANS PALILIEWU JLN. SUTOYO NO. 106 KOTAMOBAGU 21192 DR. FRANS PALILIEWU PER/04/032015RS.TRAUMA CENTRE 01/03/2015 28/02/2016

2 1400000000069 DR. FRANS PALILIEWU JLN. SUTOYO NO. 106 KOTAMOBAGU 21192 DR. FRANS PALILIEWU PER/011/032016RS.TRAUMA CENTRE 31/03/2016 31/12/2017

3 1500000000815 KLINIK PRIMA HUSADAJL. ARNOLD MONONUTU KEL. SARONGSONG II AIRMADIDI

891938CHRISTOPORUS BUDIONO

16/052015RS.TRAUMA CENTRE

01/05/2015 30/04/2016

4 1500000000815 KLINIK PRIMA HUSADA JL. ARNOLD MONONUTU KEL. SARONGSONG II AIRMADIDI

891938 CHRISTOPORUS BUDIONO


08/06/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


417 / 44607-11-201606:23:31



IKS


5 7-3645526173 KLINIK PRIMA MEDIKOM JL. A.A. MARAMIS NO.216 KELURAHAN PANIKI BAWAH KECAMATAN MAPANGET 95251 WIJOYO PER/017/06/2016 RS.TRAUMA

CENTRE 01/07/2016 31/12/2017

6 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

7 02412 RS BUDI MULIA BITUNG JL YOS SUDARSO BITUNG 21332 DR. JOHANNIS ANDRIES NAJOAN MKES. SPFK.DK


28/01/2016 31/12/2017

8 1400000000066 RS KINAPIT JLN. JENDRAL S PARMAN NO. 201 KOTAMOBAGU

21192 DR. FRANS PALILIEWU PER/03/032015 RS.TRAUMA CENTRE

01/03/2015 28/02/2016

9 1400000000066 RS KINAPIT JLN. JENDRAL S PARMAN NO. 201 KOTAMOBAGU 21192 DR. FRANS PALILIEWU PER/010/032016 RS.TRAUMA

CENTRE 31/03/2016 31/12/2017

10 1400000000068RS 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

11 1400000000068 RS ROBERT WOLTER MONGISIDI

JLN. 14 FEBRUARI TELING ATAS 876087 DR. ADHY SUGIH ARTO PER/05/032015 RS.TRAUMA CENTRE

01/03/2015 28/02/2016

12 1400000000067 RS SITTI MARYAM JLN. POGIDON RAYA NO. 110 KEC. TUMINTING

851577 DR. ANY RACHMAN PER/02/032015 RS.TRAUMA CENTRE

01/03/2015 28/02/2016

13 1400000000067 RS SITTI MARYAMJLN. POGIDON RAYA NO. 110 KEC. TUMINTING 851577 DR. ANY RACHMAN PER/005/032016

RS.TRAUMA CENTRE 01/03/2016 31/12/2017

14 1400000000078RSU PANCARAN KASIH GMIM MANADO JL SAM RATULANGI XIII MANADO 857629

DR FRANKY V T KAMBEY PER/004/032016

RS.TRAUMA CENTRE 01/03/2016 31/12/2017

15 1400000000169RSUD BOLAANG MONGONDOW SELATAN

JALAN RAYA MOLIBAGU BOLAANG MONGONDOW SELATAN

2629444 DR. TANTI KOROMPOT PER/20/102016RS.TRAUMA CENTRE

21/10/2016 31/12/2018

16 1400000000169 RSUD BOLAANG MONGONDOW SELATAN

JALAN RAYA MOLIBAGU BOLAANG MONGONDOW SELATAN

2629444 DR. TANTI KOROMPOT PER/10/032015 RS.TRAUMA CENTRE

01/06/2015 31/05/2016


Periode : 01/01/2015 s/d 31/10/2016


418 / 44607-11-201606:23:31



IKS


17 1400000000175 RSUD BOLAANG MONGONDOW UTARA

JALAN TALAGA TOMOAGU BOLANGINTANG

085241745656 DR SUGENG HERMAWAN PER/11/032015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

18 1400000000175 RSUD BOLAANG MONGONDOW UTARA

JALAN TALAGA TOMOAGU BOLANGINTANG

085241745656 DR SUGENG HERMAWAN PER/022/102016 RS.TRAUMA

CENTRE 27/10/2016 31/12/2018

19 7-2330823833 RSUP PROF DR R D KANDOU JL RAYA TANAWANGKO NO 56 95115DR. MAXI R. RONDONUWU, DHSM, MARS


02/03/2016 31/12/2017

20 1500000000352 RUMAH SAKIT BHAYANGKARA MANADO

JALAN SAM RATULANGI NO. 326 MANADO DRG. IGNATIUS HENDRA ARIFIANTO


01/03/2015 28/02/2016

21 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

22 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

23 7-5097284158 RUMAH SAKIT BUDI SETIA LANGOWAN

JALAN MELATI NO. 25 KAYOWAS 95694 PT RATNA TIMUR TUMARENDEM


13/10/2016 31/12/2017

24 1500000000816 RUMAH SAKIT LANUD SAM RATULANGI MANADO

JL. A.A MARAMIS - LAPANGAN MANADO 811077 DR. DIAN MULYAWARMAN, SP.M


30/06/2016 31/12/2017

25 1500000000816RUMAH SAKIT LANUD SAM RATULANGI MANADO JL. A.A MARAMIS - LAPANGAN MANADO 811077

DR. DIAN MULYAWARMAN, SP.M PER/17/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

26 1400000000232RUMAH SAKIT UMUM BETHESDA JALAN RAYA TOMOHON, KOTA TOMOHON 891020 DR ROBBIN R.F WAROUW PER/003/072016

RS.TRAUMA CENTRE 01/03/2016 31/12/2017

27 1400000000168RUMAH SAKIT UMUM DAERAH AMURANG

JALAN TRANS SULAWESI, AMURANG BARAT

085341986277

DR EINE CH ESTER KODONGAN


01/06/2015 31/05/2016

28 1400000000168 RUMAH SAKIT UMUM DAERAH AMURANG

JALAN TRANS SULAWESI, AMURANG BARAT

085341986277

DR EINE CH ESTER KODONGAN


12/08/2016 31/12/2017


Periode : 01/01/2015 s/d 31/10/2016


419 / 44607-11-201606:23:31



IKS


29 7-4277552623 RUMAH SAKIT UMUM DAERAH BITUNG

JL. SH SARUNDAJANG - KELURAHAN MANEMBO NEMBO TENGAH KEC. MAESA KOTA BITUNG

95511 DR. JEANESTE M WATUNA M.MKES, DK PER/019/062016 RS.TRAUMA

CENTRE 04/08/2016 31/12/2017

30 1500000000410RUMAH SAKIT UMUM DAERAH LAPANGAN SAWANG

KEL. SAWANG PULAU SIAU KAB. KEPL. SITARO

DR BOBBY HAN INKIRIWANG PER/13/032015 RS.TRAUMA

CENTRE 01/03/2015 28/02/2016

31 1500000000217RUMAH SAKIT UMUM DAERAH LIUNKENDAGE TAHUNA

JLN. TATEHE KEL APENGSEMBAKA KEC TAHUNA

DR BLESSING ROMPIS PER/016/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

32 1400000000154 RUMAH SAKIT UMUM DAERAH SAM RATULANGI

JL. SUPRAPTO KEL LUWAAN TONDANO TIMUR, MINAHASA

321172 DR. MARYANI SURONOTO


21/06/2016 31/12/2017

33 1500000000227 RUMAH SAKIT UMUM DAERAH TALAUD DESA MALA KEC. MELONGUANE TALAUD DR JAWALI JURRY

EKTIVIANUS M.KES PER/017/022015 RS.TRAUMA CENTRE 01/02/2015 31/01/2016

34 1400000000153RUMAH SAKIT UMUM HERMANA LEMBEAN

JLN. A. MONONUTU DESA LEMBEAN, MINAHASA UTARA 891020

DR. LAURENTIUS RONALD PONTOH PER/006/032016

RS.TRAUMA CENTRE 01/03/2016 31/12/2017

35 1400000000059 RUMKITAL DR. WAHYU SLAMET

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


01/03/2015 28/02/2016

36 1400000000059 RUMKITAL DR. WAHYU SLAMET

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


01/03/2016 31/12/2017

37 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

KANTOR CABANG : T01- KANTOR CABANG PALU


Periode : 01/01/2015 s/d 31/10/2016


420 / 44607-11-201606:23:31



IKS


1 7-3555580015 KLINIK AGUNG JL. RAMBA I NO. 13B PALU 94111 DR. RYZQA PER/018/052016 RS.TRAUMA CENTRE 02/06/2016 31/05/2018

2 1500000000952 POLIKLINIK PT. HARDAYA INTI PLANTATIONS PT. HARDAYA INTI PLANTATIONS 3149088 IR. YANI ANSHORI PER/008/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

3 1500000000952 POLIKLINIK PT. HARDAYA INTI PLANTATIONS

PT. HARDAYA INTI PLANTATIONS 3149088 IR. YANI ANSHORI PER/005/022016 RS.TRAUMA CENTRE

01/05/2016 30/04/2018

4 1400000000290 PUSKESMAS SALAKAN SALAKAN KABUPATEN BANGGAI KEPULAUAN

DR. JAMES HD PINONTOAN


14/01/2016 31/07/2016

5 7-2728692225 RS. BUDI AGUNG JL. MALUKU NO. 44 KOTA PALU 94231 0451-421360

DR. IDA BAGUS YADNYAPUTRA PER/013/032016 RS.TRAUMA

CENTRE 01/04/2016 31/05/2018

6 1400000000054 RSD. MADANI JL.THALUA KONCHI NO.11 MAMBORO 94111 491470 DR. ISHARWATI M.KES PER/002/012016RS.TRAUMA CENTRE 01/03/2016 28/02/2017

7 1400000000054 RSD. MADANI JL.THALUA KONCHI NO.11 MAMBORO 94111 491470 DR. ISHARWATI M.KES PER/003/022015 RS.TRAUMA CENTRE

01/03/2015 28/02/2016

8 1400000000081 RSU LUWUK JL. IMAM BONJOL NO. 14 LUWUK 21820 DR. YUSRAN KASIM ME PER/011/062015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

9 1400000000081 RSU LUWUK JL. IMAM BONJOL NO. 14 LUWUK 21820 DR. YUSRAN KASIM ME PER/003/012016RS.TRAUMA CENTRE 27/04/2016 31/03/2018

10 1400000000083 RSU. ANUTAPURA JL. KANGKUNG NO. 01 PALU 94111 462770DR. FARIDA H. INGOLO, M.KES PER/004/032015

RS.TRAUMA CENTRE 01/03/2015 28/02/2016

11 1400000000083 RSU. ANUTAPURA JL. KANGKUNG NO. 01 PALU 94111 462770DR. FARIDA H. INGOLO, M.KES


18/03/2016 28/02/2018

12 1400000000440 RSUD AMPANA JL. SULTAN HASANUDDIN NO. 32 AMPANA PER/017/082015 RS.TRAUMA CENTRE

01/11/2015 31/10/2016


Periode : 01/01/2015 s/d 31/10/2016


421 / 44607-11-201606:23:31



IKS


13 1400000000140 RSUD ANUNTALOKO JL. SIS ALJUFRI NO.214 KEL. MASIGI KAB.PARIGI 21032 DR. REVY J.N TILAAR PER/010/062015 RS.TRAUMA

CENTRE 01/06/2015 31/05/2016

14 1400000000140 RSUD ANUNTALOKO JL. SIS ALJUFRI NO.214 KEL. MASIGI KAB.PARIGI 21032 DR. REVY J.N TILAAR PER/011/032016 RS.TRAUMA

CENTRE 01/06/2016 31/05/2018

15 1400000000337 RSUD BANGGAI LAUT ADEAN KEC. BANGGAI TENGAH KAB. BANGGAI LAUT

DR. CHRISTIAN MACPAL PER/019/052016 RS.TRAUMA CENTRE

12/08/2016 31/03/2018

16 1400000000438 RSUD BUOL JL. DR. WAHIDIN SUDIROHUSODO KEL. LEOK II KEC. BIAU KAB. BUOL


01/11/2015 31/10/2016

17 1400000000231 RSUD KABELOTA JL. TRANS SULAWESI KAB. DONGGALA DRG. AMRIANI LAPASE PER/010/032016 RS.TRAUMA CENTRE 01/06/2016 31/05/2018

18 1400000000231 RSUD KABELOTA JL. TRANS SULAWESI KAB. DONGGALA DRG. AMRIANI LAPASE PER/007/052015RS.TRAUMA CENTRE 01/06/2015 31/05/2016

19 1400000000325 RSUD KOLONODALE JL. WOLTER MONGINSIDI NO.2 MOROWALI PER/021/062016 RS.TRAUMA CENTRE

01/09/2016 31/12/2018

20 1400000000325 RSUD KOLONODALE JL. WOLTER MONGINSIDI NO.2 MOROWALI PER/013/082015 RS.TRAUMA CENTRE

01/09/2015 31/08/2016

21 1400000000118 RSUD MOKOPIDO JL. LANONI NO. 37ABD. KADIR H. TAHIR SP.PD PER/019/102015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

22 1400000000324 RSUD MOROWALIJL. TRANS SULAWESI FONUASINGKO BUNGKU DR. SANDRA SUSANTY PER/022/062016

RS.TRAUMA CENTRE 01/09/2016 31/12/2018

23 1400000000324 RSUD MOROWALIJL. TRANS SULAWESI FONUASINGKO BUNGKU

DR. SANDRA SUSANTY PER/014/082015RS.TRAUMA CENTRE

01/09/2015 31/08/2016

24 1400000000277 RSUD POSO JL. JEND. SUDIRMAN NO. 33 POSO PER/020/062016 RS.TRAUMA CENTRE

01/08/2016 31/07/2018


Periode : 01/01/2015 s/d 31/10/2016


422 / 44607-11-201606:23:31



IKS


25 1400000000277 RSUD POSO JL. JEND. SUDIRMAN NO. 33 POSO PER/012/072015 RS.TRAUMA CENTRE 01/08/2015 31/07/2016

26 7-4040638832 RSUD RAJA TOMBOLOTUTU JL TRANS SULAWESI NO TINOMBO 94475 DR SITI RACHMA FATIMAH PER/26/062016 RS.TRAUMA

CENTRE 13/07/2016 13/12/2018

27 1500000000735 RSUD TORA BELO JL. POROS PALU-PALOLO DESA SIDERA 94364 DRG. HARI SETIYONO PER/005/052015 RS.TRAUMA CENTRE

01/05/2015 30/04/2016

28 1500000000735 RSUD TORA BELO JL. POROS PALU-PALOLO DESA SIDERA 94364 DRG. HARI SETIYONO PER/007/022016 RS.TRAUMA CENTRE

01/05/2016 30/04/2018

29 1400000000119 RSUD UNDATA JL. RE MARTADINATA KEL. TONDO PALU 94111 0451421270

DR. RENY A. LAMADJIDO, SP. PK. M.KES


30 1400000000119 RSUD UNDATA JL. RE MARTADINATA KEL. TONDO PALU 941110451421270

DR. RENY A. LAMADJIDO, SP. PK. M.KES


31 1400000000577 RUMAH SAKIT BALA KESELAMATAN

JL. WOODWARD NO. 01 PALU 456099 DR. MERDY CORRY MAWUNTU


01/12/2015 30/11/2016

32 1400000000628 RUMAH SAKIT BHAYANGKARA

JL. DR. SUHARSO LORONG III NO. 02 KOMPOL DR. JUDY DERMAWAN


01/12/2015 30/11/2016

33 1400000000588 RUMAH SAKIT WIRABUANA JL. SISINGAMANGARAJA NO .04 PALU DR. HARIYADI AM, SP.PD PER/021/102015RS.TRAUMA CENTRE 01/12/2015 30/11/2016

KANTOR CABANG : T02- KANTOR CABANG GORONTALO


Periode : 01/01/2015 s/d 31/10/2016


423 / 44607-11-201606:23:31



IKS


1 1400000000156 KWANDANG MEDICAL CENTER

JL TRANS SULAWESI DESA MOLUO KEC KWANDANG PER/11/042016 RS.TRAUMA

CENTRE 09/05/2016 17/04/2018

2 1500000000879 PUSKESAMAS ASPARAGA DESA BULULI KEC ASPARAGA KAB GORONTALO

DINAS KESEHATAN KABUPATEN GORONTALO


3 1500000000879 PUSKESAMAS ASPARAGA DESA BULULI KEC ASPARAGA KAB GORONTALO



01/05/2015 30/04/2016

4 1500000000908 PUSKESMAS BATUDAA DESA PANYUNGA KEC BATUDAADINAS KESEHATAN KABUPATEN GORONTALO


01/05/2015 30/04/2016

5 1500000000908 PUSKESMAS BATUDAA DESA PANYUNGA KEC BATUDAADINAS KESEHATAN KABUPATEN GORONTALO


6 1500000000886PUSKESMAS BATUDAA PANTAI

JL TRANS SULAWESI KM 38 DESA KAYUBULAN KEC BATUDAA PANTAI KAB GORONTALO



7 1500000000886 PUSKESMAS BATUDAA PANTAI

JL TRANS SULAWESI KM 38 DESA KAYUBULAN KEC BATUDAA PANTAI KAB GORONTALO



01/05/2016 31/03/2018

8 1500000000877 PUSKESMAS BILATO DESA BILATO KEC BOLIYOHUTO KAB GORONTALO



01/05/2015 30/04/2016

9 1500000000877 PUSKESMAS BILATODESA BILATO KEC BOLIYOHUTO KAB GORONTALO



10 1500000000906 PUSKESMAS BILUHUDESA LOBUTO KEC BILUHU KAB GORONTALO



11 1500000000906 PUSKESMAS BILUHUDESA LOBUTO KEC BILUHU KAB GORONTALO



01/05/2015 30/04/2016

12 1500000000883 PUSKESMAS BOLIYOHUTO DESA SIDOMULYO KEC BOLIYOHUTO KAB GORONTALO



01/05/2016 31/03/2018


Periode : 01/01/2015 s/d 31/10/2016


424 / 44607-11-201606:23:31



IKS


13 1500000000883 PUSKESMAS BOLIYOHUTO DESA SIDOMULYO KEC BOLIYOHUTO KAB GORONTALO



14 7-4123596933 PUSKESMAS BONGO DUA DESA BONGO II KEC. PAGUYAMAN KAB. BOALEMO 96262 PUSKESMAS BONGO II PER/13/052016 RS.TRAUMA

CENTRE 27/07/2016 31/12/2018

15 1500000000880 PUSKESMAS BUHU DESA BUHU KEC TIBAWA KAB GORONTALO



01/05/2016 31/03/2018

16 1500000000880 PUSKESMAS BUHU DESA BUHU KEC TIBAWA KAB GORONTALO



01/05/2015 30/04/2016

17 1500000000884 PUSKESMAS DUNGALIYO DESA KALIYOSO KEC BONGOMEME KAB GORONTALO

DINAS KESEHATAN KAB GORONTALO PER/06/052015 RS.TRAUMA

CENTRE 01/05/2015 30/04/2016

18 1500000000884 PUSKESMAS DUNGALIYODESA KALIYOSO KEC BONGOMEME KAB GORONTALO

DINAS KESEHATAN KAB GORONTALO PER/09/042016

RS.TRAUMA CENTRE 01/05/2016 31/03/2018

19 1500000000864 PUSKESMAS LIMBOTO JL TILONGKABILA KEL HEPUHULAWA KEC LIMBOTO

96211DINAS KESEHATAN KABUPATEN GORONTALO


01/05/2016 31/03/2018

20 1500000000864 PUSKESMAS LIMBOTO JL TILONGKABILA KEL HEPUHULAWA KEC LIMBOTO

96211DINAS KESEHATAN KABUPATEN GORONTALO


01/05/2015 30/04/2016

21 1500000000870PUSKESMAS LIMBOTO BARAT

JL TRANS SULAWESI DESA YOSONEGORO KEC LIMBOTO BARAT



22 1500000000870PUSKESMAS LIMBOTO BARAT

JL TRANS SULAWESI DESA YOSONEGORO KEC LIMBOTO BARAT



23 1500000000881 PUSKESMAS MOLOPATODUDESA MOLOPATODU KEC BONGOMEME KAB GORONTALO



01/05/2016 31/03/2018

24 1500000000881 PUSKESMAS MOLOPATODU DESA MOLOPATODU KEC BONGOMEME KAB GORONTALO



01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


425 / 44607-11-201606:23:31



IKS


25 1500000000875 PUSKESMAS MOOTILANGO DESA PARIS KEC MOOTILANGO KAB GORONTALO



26 1500000000875 PUSKESMAS MOOTILANGO DESA PARIS KEC MOOTILANGO KAB GORONTALO



27 1500000000876 PUSKESMAS PILOHAYANGA DESA DULOHUPA KEC TELAGA KAB GORONTALO



01/05/2016 31/03/2018

28 1500000000876 PUSKESMAS PILOHAYANGA DESA DULOHUPA KEC TELAGA KAB GORONTALO



01/05/2015 30/04/2016

29 1500000000878 PUSKESMAS PULUBALA DESA PONGONGAILA KEC PULUBALA KAB GORONTALO



30 1500000000878 PUSKESMAS PULUBALADESA PONGONGAILA KEC PULUBALA KAB GORONTALO



31 1500000000885 PUSKESMAS TABONGO DESA TABONGO BARAT KEC TABONGO KAB GORONTALO



01/05/2016 31/03/2018

32 1500000000885 PUSKESMAS TABONGO DESA TABONGO BARAT KEC TABONGO KAB GORONTALO



01/05/2015 30/04/2016

33 1500000000910 PUSKESMAS TELAGAJALAN LIMBOTO RAYA DESA MONGOLATOKEC TELAGA



34 1500000000910 PUSKESMAS TELAGAJALAN LIMBOTO RAYA DESA MONGOLATOKEC TELAGA



35 1500000000905 PUSKESMAS TELAGA BIRUJL LIMBOTO RAYA DESA TULADENGGI KECTELAGA BIRU



01/05/2016 31/03/2018

36 1500000000905 PUSKESMAS TELAGA BIRU JL LIMBOTO RAYA DESA TULADENGGI KECTELAGA BIRU



01/05/2015 30/04/2016


Periode : 01/01/2015 s/d 31/10/2016


426 / 44607-11-201606:23:31



IKS


37 1500000000907 PUSKESMAS TELAGA JAYA DESA HUTADAA KEC TELAGA JAYA KAB GORONTALO



38 1500000000907 PUSKESMAS TELAGA JAYA DESA HUTADAA KEC TELAGA JAYA KAB GORONTALO



39 1500000000904 PUSKESMAS TIBAWA DESA ISIMU SELATAN KEC TIBAWA KAB GORONTALO



01/05/2016 31/03/2018

40 1500000000904 PUSKESMAS TIBAWA DESA ISIMU SELATAN KEC TIBAWA KAB GORONTALO



01/05/2015 30/04/2016

41 1500000000909 PUSKESMAS TILANGO DESA TILOTE KEC TILANGO KAB GORONTALO



42 1500000000909 PUSKESMAS TILANGODESA TILOTE KEC TILANGO KAB GORONTALO



43 1500000000874 PUSKESMAS TOLANGOHULA

DESA SUKA MAKMUR KEC TOLANGOHULAKAB GORONTALO



01/05/2016 31/03/2018

44 1500000000874 PUSKESMAS TOLANGOHULA

DESA SUKA MAKMUR KEC TOLANGOHULAKAB GORONTALO



01/05/2015 30/04/2016

45 1400000000104 RSUD M.M.DUNDAJLN ACHMAD A. WAHAB NO 53 KEC LIMBOTO 881455 RSUD DR M.M DUNDA PER/03/042015

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

46 1400000000104 RSUD M.M.DUNDAJLN ACHMAD A. WAHAB NO 53 KEC LIMBOTO 881455 RSUD DR M.M DUNDA PER/01/012016

RS.TRAUMA CENTRE 10/02/2016 31/12/2017

47 1400000000477 RSUD OTANAHAJL RAMBUTAN NO 413 KEL BULADU KEC KOTA BARAT

RSUD OTANAHA PER/02/012016RS.TRAUMA CENTRE

01/03/2016 31/12/2017

48 1400000000477 RSUD OTANAHA JL RAMBUTAN NO 413 KEL BULADU KEC KOTA BARAT

RSUD OTANAHA PER/10/112014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


427 / 44607-11-201606:23:31



IKS


49 1400000000105 RSUD POHUWATO PER/14/092016 RS.TRAUMA CENTRE 01/10/2016 30/09/2018

50 1400000000105 RSUD POHUWATO PER/11/092015 RS.TRAUMA CENTRE 14/09/2016 30/09/2016

51 1400000000102 RSUD 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

52 1400000000102 RSUD PROF DR. H. ALOEI SABOE

JL PROF DR H ALOEI SABOE KEL WONGKADITI TIMUR

RSUD PROF DR. H. ALOEI SABOE


01/01/2015 31/12/2015

53 1400000000103 RSUD TANI DAN NELAYAN JL TRANS SULAWESI KAB BOALEMO PER/15/102015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

54 1400000000103 RSUD TANI DAN NELAYAN JL TRANS SULAWESI KAB BOALEMO PER/04/012016RS.TRAUMA CENTRE 27/07/2016 31/12/2018

55 1400000000155 RSUD TOTO KABILA JL KESEHATAN NO 25 DESA PERMATA KEC TILONGKABILA

8701943 RSUD TOTO KABILA PER/01/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

56 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

57 1400000000157 RSUD ZAINAL UMAR SIDIKIDESA BULALO KEC KWANDANG KAB GORUT 96252

RSUD ZAINAL UMAR SIDIKI PER/10/042016

RS.TRAUMA CENTRE 20/04/2016 31/03/2018

58 1500000001830RUMAH SAKIT ISLAM GORONTALO

JL PROF DR HB JASSIN NO 457 KOTA GORONTALO 96128 830820

YAYASAN KESEJAHTERAAN UMAT HASANAH GORONTALO


59 1500000001830RUMAH SAKIT ISLAM GORONTALO

JL PROF DR HB JASSIN NO 457 KOTA GORONTALO

96128 830820YAYASAN KESEJAHTERAAN UMAT HASANAH GORONTALO


01/05/2015 30/04/2016

60 1400000000472 RUMAH SAKIT UMUM BUNDA

JL PROF DR HB JASSIN KEL WUMIALO KEC KOTA TENGAH

829290 DANIEL RANTI PER/03/012016 RS.TRAUMA CENTRE

04/04/2016 03/01/2018


Periode : 01/01/2015 s/d 31/10/2016


428 / 44607-11-201606:23:31


KANTOR CABANG : W00- KANTOR CABANG MAKASSAR


IKS


1 1500000000032 BALAI LATIHAN KERJA INDUSTRI MAKASSAR

JL.TAMAN MAKAM PAHLAWAN NO 4 PER/41/122014 RS.TRAUMA CENTRE

06/01/2015 06/01/2016

2 1500000000032 BALAI LATIHAN KERJA INDUSTRI MAKASSAR JL.TAMAN MAKAM PAHLAWAN NO 4 PER/012/012016 RS.TRAUMA

CENTRE 16/03/2016 07/01/2018

3 1500000000110 BALAI LATIHAN KERJA INDUSTRI MAKASSAR JL TAMAN MAKAM PAHLAWAN NO 4 PER/41/122014 RS.TRAUMA

CENTRE 06/01/2015 06/01/2016

4 1500000000027 BALAI LATIHAN KERJA KOTAMADYA PARE PARE JL BAU MASSEPE, PARE-PARE 23046 PER/019/012016 RS.TRAUMA

CENTRE 16/03/2016 04/01/2018

5 1400000000117 HEALTH AND NUTRITION CLINIC

JL PERINTIS KEMERDEKAAN KM 8 KOMP RUKO ANTARA NO 25

581983 PROF.DR.DR.HJ.SURYANI AS'AD M,SC,SP.GK


01/01/2015 31/12/2015

6 1400000000117 HEALTH AND NUTRITION CLINIC

JL PERINTIS KEMERDEKAAN KM 8 KOMP RUKO ANTARA NO 25 581983 PROF.DR.DR.HJ.SURYANI

AS'AD M,SC,SP.GK PER/009/012016 RS.TRAUMA CENTRE 16/03/2016 04/01/2018

7 7-2377521926KLINIK IMEDICAL SPECIALIST CENTRE JL. RACING CENTRE NO 17/39 MAKASSAR 90231

DR.DR.MASYITA GAFFAR, SP.THT-KL PER/001/012016

RS.TRAUMA CENTRE 07/03/2016 04/01/2018

8 07808 KLINIK PAJJAIANG JLN PAJJAIANGRUKO PELANGI NO 1 399696477 RUSMAN,S.SI.APT PER/37/062015 KAPITASI 01/06/2015 31/05/2016

9 07678 KLINIK SEHAT 24 JAM MAKASSAR

JLN PENGAYOMAN RUKO PERMATSARI NO 3

2940091 DR MUH FIRDAUS KASIM PER/36/062015 FFS 01/06/2015 31/05/2016

10 1400000000075 KLINIK SEROJA JL. GOA RIA NO. 106 SUDIANG 550228 DR. MOH. HELMY JUSUF PER/27/032015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

11 1400000000075 KLINIK SEROJA JL. GOA RIA NO. 106 SUDIANG 550228 DR. MOH. HELMY JUSUF PER/008/012016RS.TRAUMA CENTRE 16/03/2016 04/01/2018

12 7-4309078497KLINIK UTAMA DOKTER SPESIALIS CEREBELLUM

JL. SWADAYA NO. 4 (BELAKANG BALAI KESEHATAN PARU), MAKASSAR 90231 00000000

A. LAILA MUFIDA ROEM, SH PER/040/062016

RS.TRAUMA CENTRE 09/08/2016 01/03/2018


Periode : 01/01/2015 s/d 31/10/2016


429 / 44607-11-201606:23:31



IKS


13 1400000000161 PUSKESMAS BUNGORO KECAMATAN BUNGORO KAB PANGKEP 4291557 DRG ANWAR NUHUNG PER/21/032015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

14 1400000000161 PUSKESMAS BUNGORO KECAMATAN BUNGORO KAB PANGKEP 4291557 DRG ANWAR NUHUNG PER/016/012016 RS.TRAUMA CENTRE 16/03/2016 04/01/2018

15 1400000000170 RS AKADEMIS JAURY JUSUF PUTERA

JL JEND M JUSUF NO 57 A MAKASSAR 317343 PER/29/032015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

16 1400000000170 RS AKADEMIS JAURY JUSUF PUTERA

JL JEND M JUSUF NO 57 A MAKASSAR 317343 PER/011/012016 RS.TRAUMA CENTRE

14/03/2016 04/01/2018

17 1400000000044 RS AWAL BROS MAKASSAR JL. JENDRAL URIP SUMOHARJO NO. 43 454567 PT MAKASSAR GLOBAL AWAL BROS PER/25/032015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

18 1400000000044 RS AWAL BROS MAKASSAR JL. JENDRAL URIP SUMOHARJO NO. 43 454567PT MAKASSAR GLOBAL AWAL BROS PER/006/012016

RS.TRAUMA CENTRE 24/02/2016 31/12/2017

19 1500000000108 RS DR M YASIN BONE JL JENDRAL SUDIRMAN WATAMPONE BONE


14/03/2016 04/01/2018

20 1400000000046 RS ISLAM FAISAL MAKASSAR

JALAN ANDI PANGERAN PETTARANI MAKASSAR

871942 PROF DR H SYAFRUDDIN WAHID PHD,SP,PA(K)


01/01/2015 31/12/2015

21 1400000000046RS ISLAM FAISAL MAKASSAR

JALAN ANDI PANGERAN PETTARANI MAKASSAR 871942

PROF DR H SYAFRUDDIN WAHID PHD,SP,PA(K) PER/004/012016

RS.TRAUMA CENTRE 07/03/2016 04/01/2018

22 7-4961237241RS KHUSUS DAERAH PROVINSI SULAWESI SELATAN

JL. LANTO DG PASEWANG NO. 34 MAKASAR 90142

0411873120

PEMERINTAH PROVINSI SULAWESI SELATAN PER/045/092016

RS.TRAUMA CENTRE 27/09/2016 01/09/2018

23 7-3014071433RS STELLA MARIS MAKASSAR

JL. SOMBA OPU 273 KEL. MALOKU, KEC. UJUNG PANDANG, KOTA MAKASSAR

901110411854341

KONGREGASI SUSTER JMJ

PER/ 032 /032016

RS.TRAUMA CENTRE

14/06/2016 01/03/2018

24 1500000000332 RS TNI AU DR DODY SARJOTO

JL DAKOTA NO. 1 LANUD SULTAN HASANUDDIN


16/03/2015 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


430 / 44607-11-201606:23:31



IKS


25 7-3504488523 RSK DR. TADJUDDIN CHALID MAKASSAR

JL. PACCERAKKANG NO. 67/ JL. PAJJAIYANG, DAYA, MAKASSAR 90241 041151290

2KEMENTERIAN KESEHATAN PER/037/052016 RS.TRAUMA

CENTRE 24/05/2016 16/05/2018

26 1500000000333 RSU HIKMAH JL YOSEF LATUMAHINA NO 1 872284 PER/014/012016 RS.TRAUMA CENTRE 14/03/2016 04/01/2018

27 1500000000333 RSU HIKMAH JL YOSEF LATUMAHINA NO 1 872284 PER/45/122014 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

28 1500000000028 RSU LASINRANG PINRANG JL MACAN NO 9 KABUPATEN PINRANG 921118 PER/020/012016 RS.TRAUMA CENTRE

14/03/2016 04/01/2018

29 1400000000190 RSUD ANDI MAKASSAU JL NURUSSAMAWATI NO 9 PAREPARE 21163 II.DR. H. KAMARUDDIN SAID, SP.B, MARS PER/23/032015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

30 1400000000190 RSUD ANDI MAKASSAU JL NURUSSAMAWATI NO 9 PAREPARE 21163II.DR. H. KAMARUDDIN SAID, SP.B, MARS PER/23/012015

RS.TRAUMA CENTRE 18/03/2016 04/05/2017

31 1500000000299 RSUD BARRU PER/018/012016 RS.TRAUMA CENTRE

14/03/2016 04/01/2018

32 1400000000338 RSUD H. ANDI SULTHAN DAENG RADJA

JL. SERIKAYA NO 17 BULUKUMBA 84637 PEMERINTAH KAB BULUKUMBA


14/03/2016 04/01/2018

33 1500000000033 RSUD HAJI MAKASSAR JL DG MASEPPE PER/43/122014RS.TRAUMA CENTRE 02/01/2015 31/12/2015

34 1500000000033 RSUD HAJI MAKASSAR JL DG MASEPPE PER/013/012016RS.TRAUMA CENTRE 14/03/2016 04/01/2018

35 1400000000171RSUD HAJI PADJONGA DAENG NGALLE

JL INCE HUSEIN DAENG PARANI NO 1 21065 PER/021/012016RS.TRAUMA CENTRE

14/03/2016 04/01/2018

36 1400000000171 RSUD HAJI PADJONGA DAENG NGALLE

JL INCE HUSEIN DAENG PARANI NO 1 21065 PER/20/032015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


431 / 44607-11-201606:23:31



IKS


37 7-3799579913 RSUD K. H. HAYYUNG KEPULAUAN SELAYAR

JL. K. H. ABD. KADIR KASIM, KEPULAUAN SELAYAR 92812 041123130

33PEMERINTAH KABUPATEN SELAYAR PER/038/052016 RS.TRAUMA

CENTRE 15/06/2016 18/05/2018

38 1500000000021 RSUD KONDOSAPATA' KAB. MAMASA

JALAN POROS BALAMBANG KEL. MINAKE KEC. TANDUKKALUA' KAB. MAMASA PER/005/012016 RS.TRAUMA

CENTRE 14/03/2016 04/01/2018

39 1400000000345 RSUD LAMADUKELLENG SENGKANG WAJO

JL KARTIKA CANDRA KIRANA SENGKANG PER/027/012016 RS.TRAUMA CENTRE

14/03/2016 04/01/2018

40 1400000000345 RSUD LAMADUKELLENG SENGKANG WAJO

JL KARTIKA CANDRA KIRANA SENGKANG PER/19/032015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

41 1400000000173 RSUD LANTO DAENG PASEWANG JL LINGKAR KARISA BONTOSUNGGU NO 21004 PER/022/012016 RS.TRAUMA

CENTRE 14/03/2016 04/01/2018

42 1400000000173RSUD LANTO DAENG PASEWANG JL LINGKAR KARISA BONTOSUNGGU NO 21004 PER/24/032015

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

43 1400000000195 RSUD LATEMMAMALA JL MALAKA RAYA WATANSOPPENG PER/30/032015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

44 1400000000195 RSUD LATEMMAMALA JL MALAKA RAYA WATANSOPPENG PER/026/012016 RS.TRAUMA CENTRE

14/03/2016 04/01/2018

45 1500000000109 RSUD MAJENE JALAN POROS MAJENE MAMUJU PER/029/012016RS.TRAUMA CENTRE 14/03/2016 04/01/2018

46 1400000000462 RSUD MAMUJU JL KURUNGAN BASSI 21107 PER/028/012016RS.TRAUMA CENTRE 14/03/2016 04/01/2018

47 1400000000189 RSUD PANGKEP JL ST HASANUDDIN KABUPATEN PANGKEP 2311118 ARMAN PER/02/032015RS.TRAUMA CENTRE

01/01/2015 31/12/2015

48 1400000000189 RSUD PANGKEP JL ST HASANUDDIN KABUPATEN PANGKEP 2311118 ARMAN PER/017/012016 RS.TRAUMA CENTRE

14/03/2016 04/01/2018


Periode : 01/01/2015 s/d 31/10/2016


432 / 44607-11-201606:23:31



IKS


49 7-4849028015 RSUD POLEWALI MANDAR JL. RATULANGI NO, POLEWALI MANDAR 91315 042222799PEMERINTAH KABUPATEN POLEWALI MANDAR


50 1400000000339 RSUD PROF. DR. H. M. ANWAR MAKKATUTU JL. TERATAI NO. 20 BANTAENG 23126 PEMERINTAH KAB.

BANTAENG PER/023/012016 RS.TRAUMA CENTRE 14/03/2016 04/01/2018

51 1400000000172 RSUD SALEWANGANG MAROS

JL POROS MAROS MAKASSAR KM 3 371166 PER/28/032015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

52 1400000000172 RSUD SALEWANGANG MAROS

JL POROS MAROS MAKASSAR KM 3 371166 PER/015/012016 RS.TRAUMA CENTRE

14/03/2016 04/01/2018

53 1400000000077 RSUD SAYANG RAKYAT MAKASSAR

JL. PAHLAWAN NO. 1000 KEL. BULUROKENG KEC. BIRINGKANAYA 5068931 PEMERINTAH PROVINSI

SULAWESI SELATAN PER/18/032015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

54 1400000000077RSUD SAYANG RAKYAT MAKASSAR

JL. PAHLAWAN NO. 1000 KEL. BULUROKENG KEC. BIRINGKANAYA 5068931

PEMERINTAH PROVINSI SULAWESI SELATAN PER/007/012016

RS.TRAUMA CENTRE 14/03/2016 04/01/2018

55 1400000000213 RSUD SINJAI JL. JEND SUDIRMAN NO 47 KEL BIRINGERE KEC SINJAI UTARA

21132 PEMDA KAB SINJAI PER/22/032015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

56 1500000000480 RSUD SYEKH YUSUF KABUPATEN GOWA

JL DR WAHIDIN SUDIRO HUSODO NO 48 SUNGGUMINASA


14/03/2016 15/01/2018

57 1500000000480RSUD SYEKH YUSUF KABUPATEN GOWA

JL DR WAHIDIN SUDIRO HUSODO NO 48 SUNGGUMINASA 99257248 PER/14/022015

RS.TRAUMA CENTRE 14/01/2015 14/01/2016

58 1500000000111RSUP DR WAHIDIN SUDIROHUSODO MAKASSAR

JL PERINTIS KEMERDEKAAN KM 11 TAMALANREA PER/003/012016

RS.TRAUMA CENTRE 01/03/2016 04/01/2018

59 1500000000111RSUP DR WAHIDIN SUDIROHUSODO MAKASSAR

JL PERINTIS KEMERDEKAAN KM 11 TAMALANREA


02/01/2015 31/12/2015

60 1400000000162 RUMAH SAKIT BHAYANGKARA MAKASSAR

JL. LETJEND. POL. MAPPAOUDANG NO. 63 836344 KEPOLISIAN NEGARA REPUBLIK INDONESIA


01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


433 / 44607-11-201606:23:31



IKS


61 1400000000162 RUMAH SAKIT BHAYANGKARA MAKASSAR JL. LETJEND. POL. MAPPAOUDANG NO. 63 836344 KEPOLISIAN NEGARA

REPUBLIK INDONESIA PER/010/012016 RS.TRAUMA CENTRE 14/03/2016 04/01/2018

62 1500000001893 SILOAM HOSPITALS JL METRO TANJUNG BUNGA KAV 9 90134 3662900 PER/34/052015 RS.TRAUMA CENTRE 07/04/2015 06/04/2017

KANTOR CABANG : W01- KANTOR CABANG KENDARI


IKS


1 7-477552713BLUD RSU BAHTERA MAS SULTRA JL KAPTEN PIERE TENDEAN 93114 PEMDA PROV SULTRA PER/002/042015

RS.TRAUMA CENTRE 04/12/2015 01/04/2017

2 7-477552713 BLUD RSU BAHTERA MAS SULTRA

JL KAPTEN PIERE TENDEAN 93114 PEMDA PROV SULTRA PER/002/042015 RS.TRAUMA CENTRE

24/11/2015 31/03/2017

3 1400000000193 BLUD RSU KONAWE SELATAN

JL POROS ANDOLOO NO.1PEMERINTAH KABUPATEN KONAWE SELATAN


09/05/2016 28/03/2018

4 1500000000583 PUSKESMAS ABELI JL SEWANGI NO 2 KEL ABELI KEC ABELIDINAS KESEHATAN KOTA KENDARI PER/03/042015

RS.TRAUMA CENTRE 16/04/2015 15/04/2016

5 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

6 1400000000293 RS SANTA ANNA KENDARI JL. DR. MOH HATTA NO 65 A 41916365PT CITRA RATNA NIRMALA


21/10/2016 30/09/2018

7 1500000001056 RS TNI AD TK.IV DR R ISMOYO

JL. LAUTE NO. 1 KENDARI KODAM VII WIRABUANA PER/04/052015 RS.TRAUMA CENTRE

25/05/2015 24/05/2016


Periode : 01/01/2015 s/d 31/10/2016


434 / 44607-11-201606:23:31



IKS


8 1500000001056 RS TNI AD TK.IV DR R ISMOYO JL. LAUTE NO. 1 KENDARI KODAM VII WIRABUANA PER/21/052016 RS.TRAUMA

CENTRE 06/06/2016 24/05/2018

9 1400000000062 RSUD KOTA KENDARI JL BRIGJEN Z.A SUGIANTO NO.39 DINAS KESEHATAN KOTA KENDARI PER/004/012016 RS.TRAUMA

CENTRE 22/02/2016 04/02/2017

10 1400000000381 RSUD KAB KOLAKA (BLUD) JL.WR SUPRATMAN NO 20 32213700 DINAS KESEHATAN KOLAKA


25/02/2016 08/02/2018

11 1400000000422 RSUD KAB KONAWE JL. DIPONEGORO NO 301 DINAS KESEHATAN KAB.KONAWE


09/05/2016 03/04/2018

12 1400000000230 RSUD KOTA BAU BAU JL LA ODE MANARFA DINKES KESEHATAN KOTA BAU BAU PER/008/022016 RS.TRAUMA

CENTRE 09/05/2016 01/02/2018

13 1500000000526RUMKIT BHAYANGKARA KENDARI. JL. Y WAYONG NO. 7 3121253

POLDA SULAWESI TENGGARA PER/02/042015

RS.TRAUMA CENTRE 14/04/2015 13/04/2017

KANTOR CABANG : W02- KANTOR CABANG PALOPO


IKS


1 1500000000095ANNIDA WOUND CARE CENTRE JL PATIMURA SAMPING KANTOR BAPEDA 14201909

PAK ASWARDI, DR SYUKUR PER/16/012016

RS.TRAUMA CENTRE 23/08/2016 31/12/2017

2 1500000000095ANNIDA WOUND CARE CENTRE

JL PATIMURA SAMPING KANTOR BAPEDA 14201909PAK ASWARDI, DR SYUKUR


01/01/2015 31/12/2015

3 1400000000215 BLUD RSUD I LAGALIGO JL SANGKURUWIRA KEC WOTU 4216001 BLUD RSUD I LAGALIGO PER/09/062016 RS.TRAUMA CENTRE

16/06/2016 31/05/2017


Periode : 01/01/2015 s/d 31/10/2016


435 / 44607-11-201606:23:31



IKS


4 1500000001802 DR ADI SASTRAWIJATA SP.B JL POROS BELOPA PALOPO 342620237 DR ADI SASTRAWIJAYA PER/11/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

5 1500000001332 DR ERICK GAMALIEL AMBA M.KES SP.OT JL ANDI DJEMMA NO 06 PALOPO 357401801 DR ERICK GAMALIEL

AMBA M.KES SP.OT PER/10/062015 RS.TRAUMA CENTRE 01/06/2015 31/05/2016

6 1500000001332 DR ERICK GAMALIEL AMBA M.KES SP.OT

JL ANDI DJEMMA NO 06 PALOPO 357401801 DR ERICK GAMALIEL AMBA M.KES SP.OT


21/06/2016 31/05/2017

7 1500000000097 DR YAIN PANGGALO JL PONGTIKU RANTEPAO 255009811 DR YAIN PANGGALO PER/02/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

8 1500000000097 DR YAIN PANGGALO JL PONGTIKU RANTEPAO 255009811 DR YAIN PANGGALO PER/01/012016 RS.TRAUMA CENTRE 23/08/2016 31/12/2017

9 1500000000096 LEONY WOUND CARE JL SUNAGI PAREMAN PAMMANU 398362717ASRIEL TALARAN DAN DR DR MAHDUR PER/03/012015

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

10 1500000000096 LEONY WOUND CARE JL SUNAGI PAREMAN PAMMANU 398362717 ASRIEL TALARAN DAN DR DR MAHDUR


23/08/2016 31/12/2017

11 1500000000098 PUSKESMAS BUA JL TANDIPAU KEC BUA PALOPO 342718401 DR BUNADI PER/01/012015 RS.TRAUMA CENTRE

01/01/2015 31/12/2015

12 1500000000098 PUSKESMAS BUA JL TANDIPAU KEC BUA PALOPO 342718401 DR BUNADI PER/14/012016RS.TRAUMA CENTRE 23/08/2016 31/12/2017

13 1400000000049 RS BINTANG LAUT JL K.H.M. KASIM NO 5 21302YAYASAN RATNA MIRIAM PER/04/032016

RS.TRAUMA CENTRE 16/06/2016 28/02/2017

14 1400000000049 RS BINTANG LAUT JL K.H.M. KASIM NO 5 21302YAYASAN RATNA MIRIAM


01/03/2015 29/02/2016

15 08339 RS BINTANG LAUT PALOPO K. H. M KASIM NO. 5 21302 YAYASAN RATNA MIRIAM


25/02/2016 29/02/2016


Periode : 01/01/2015 s/d 31/10/2016


436 / 44607-11-201606:23:31



IKS


16 1500000000128 RS HIKMAH JL IR SOEKARNO KEL KAPUNNA KEC MASAMBA 87248801 DR ISWANTO PER/11/062016 RS.TRAUMA

CENTRE 16/06/2016 31/05/2017

17 1500000000128 RS HIKMAH JL IR SOEKARNO KEL KAPUNNA KEC MASAMBA 87248801 DR ISWANTO PER/06/012015 RS.TRAUMA

CENTRE 01/01/2015 31/12/2015

18 7-4218036048 RSU ARIFIN NU'MANG JL JENDERAL AHMAD YANI NO 1 RAPPANG 91691 36801380 DR H BUDI SANTOSO MSI PER/09/062016 RS.TRAUMA CENTRE

03/08/2016 31/05/2017

19 1500000000838 RSU AT MEDIKA PALOPO JL ANDI DJEMMA NO 06 97822888 YAYASAN AT MEDIKA PER/10/052016 RS.TRAUMA CENTRE

16/06/2016 30/04/2017

20 1500000000838 RSU AT MEDIKA PALOPO JL ANDI DJEMMA NO 06 97822888 YAYASAN AT MEDIKA PER/07/052015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

21 1400000000144 RSUD ANDI DJEMMA JL SULTAN HASANUDDIN MASAMBA 21188 PEMERINTAH DAERAH PER/17/122015RS.TRAUMA CENTRE 16/06/2016 31/12/2016

22 1400000000211 RSUD BATARA GURU JL TOMAKAKA LIBANI BELOPA 3314100 RSUD BATARA GURU PER/08/062016 RS.TRAUMA CENTRE

16/06/2016 31/05/2017

23 1500000000868 RSUD LAKIPADADA JL PONGTIKU MANDETEK TANA TORAJA PEMDA KAB TANA TORAJA


16/06/2016 31/05/2017

24 1500000000868 RSUD LAKIPADADA JL PONGTIKU MANDETEK TANA TORAJAPEMDA KAB TANA TORAJA PER/09/052015

RS.TRAUMA CENTRE 01/05/2015 30/04/2016

25 1400000000384 RSUD MASSENREMPULU JL JENDERAL SUDIRMAN DR H SISWANDI M KES PER/05/062016RS.TRAUMA CENTRE 16/06/2016 31/05/2017

26 1500000000094 RSUD NENE MALLOMOJL. WOLTER MONGINSIDI PANGKAJENE MARITENGNGAE KAB. PANGKAJENE SIDRAP

081244749330

DRG. HJ. HASNANI RAPI, M.KES


01/01/2015 31/12/2015

27 7-3868161973 RUMAH SAKIT MUJAISYAH JL DR RATULANGI KM 5 POROS BALANDAI KOTA PALOPO

91914 HJ SITTI AISYAH 154/SPK/RS.M/V/2016

RS.TRAUMA CENTRE

21/06/2016 31/05/2017


Periode : 01/01/2015 s/d 31/10/2016


437 / 44607-11-201606:23:31



IKS


28 1500000000869 RUMAH SAKIT UMUM ELIM RANTEPAO JL A. YANI NO 68 RANTEPAO 21258 YAYASAN KESEHATAN

GEREJA TORAJA PER/06/062016 RS.TRAUMA CENTRE 16/06/2016 31/05/2017

29 1500000000869 RUMAH SAKIT UMUM ELIM RANTEPAO JL A. YANI NO 68 RANTEPAO 21258 YAYASAN KESEHATAN

GEREJA TORAJA PER/08/052015 RS.TRAUMA CENTRE 01/05/2015 30/04/2016

KANTOR CABANG : W21- KABUPATEN SINJAI


IKS


1 7-2015740298 RSUD SINJAI JLN JEND SUDIRMAN NO. 47 SINJAI 92611 048221132PEMERINTAH DAERAH KAB SINJAI PER/002/012016

RS.TRAUMA CENTRE 16/02/2016 03/01/2018

KANTOR CABANG : X00- KANTOR CABANG BALI DENPASAR


IKS


1 1500000000653 BRSUD TABANAN JL. PAHLAWAN NO. 14 TABANAN 82111 811027DR I NYOMAN SUSILA, M.KES PER/07/022016

RS.TRAUMA CENTRE 13/04/2016 31/01/2018

2 1500000000653 BRSUD TABANAN JL. PAHLAWAN NO. 14 TABANAN 82111 811027DR I NYOMAN SUSILA, M.KES


01/05/2015 31/12/2016

3 7-4160863428 DR MARIA WAHYU DARUKI (TABANAN)

JL. BATUKARU NO.2, TUAKILANG, TABANAN

82111 0361810804

PT BHAKTI RAHAYU PER/28/072016 RS.TRAUMA CENTRE

26/07/2016 31/12/2017

4 1500000000100DR NI PUTU DIAN SULISTYAWATI, MM (24 JAM)

RUKO BLOK I-J DALUNG JL PADANG LIWIH NO 143 DALUNG

DR NI PUTU DIAN SULISTYAWATI, MM


01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


438 / 44607-11-201606:23:31



IKS


5 7-4160215235 DR. NI NYMN SRI RAHAYU WULANDARI (SANUR) JL. DANAU BUYAN NO 7 SANUR 80221 PT. BHAKTI RAHAYU PER/28/072016 RS.TRAUMA

CENTRE 26/07/2016 31/12/2017

6 1500000000139 KLINIK ANUGERAH JL NANGKA NO 87 A DENPASAR PER/03/012015 RS.TRAUMA CENTRE 01/02/2015 31/12/2015

7 1500000000139 KLINIK ANUGERAH JL NANGKA NO 87 A DENPASAR PER/28/072016 RS.TRAUMA CENTRE

26/07/2016 31/12/2017

8 7-4159592973 KLINIK BHAKSENA IDT JL DIPONEGORO NO 150 RUKO B32-34 KOMPLEK PERTOKOAN IDT DENPASAR

80112 PT. BHAKTI RAHAYU PER/28/072016 RS.TRAUMA CENTRE

26/07/2016 31/12/2017

9 7-4159757334 KLINIK BHAKSENA TRAGIAJL BY PASS NUSA DUA (PERTOKOAN TRAGIA) NUSA DUA KUTA SELATAN BADUNG

80361 PT. BHAKTI RAHAYU PER/28/072016 RS.TRAUMA CENTRE 26/07/2016 31/12/2017

10 7-4160383236 KLINIK BHAKTI RAHAYU JL RAYA PADANGLUWIH NO 88 B DALUNG 80112 PT BHAKTI RAHAYU PER/28/072016RS.TRAUMA CENTRE 26/07/2016 31/12/2017

11 7-4160727087 KLINIK MONANG MANING JL GUNUNG BATUKARU NO 86 MONANG MANING

80112 PT BHAKTI RAHAYU PER/28/072016 RS.TRAUMA CENTRE

26/07/2016 31/12/2017

12 7-3768907586 KLINIK RAYA KUTA 62 JL RAYA TUBAN 62 DENPASAR 80361 0361758033

DRG ENDANG BEKTI H PER/23/062016 RS.TRAUMA CENTRE

14/06/2016 31/12/2018

13 1500000000078KLINIK UTAMA PADMA BAHTERA MEDICAL CENTRE JL HAYAM WURUK NO 240 246701 PER/19/122014

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

14 1500000000451 RS BHAYANGKARA TRIJATA JL TRIJATA NO 32 222908 POLRIPER / 06 / 022015

RS.TRAUMA CENTRE 01/03/2015 28/02/2017

15 1500000000453 RS INDERA PROVINSI BALI JALAN ANGSOKA NO. 8DR. NI MADE YUNITI., MM


01/04/2015 31/12/2016

16 1500000001931 RS KASIH IBU DENPASAR JL. TEUKU UMAR NO 120 DENPASAR 80111 3003030 PER/19/082015 RS.TRAUMA CENTRE

01/08/2015 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


439 / 44607-11-201606:23:31



IKS


17 1500000001933 RS KASIH IBU KEDONGANAN

JL. ULUWATU NO 69A KEDONGANAN JIMBARAN BADUNG 80351 703270 PER/21/082015 RS.TRAUMA

CENTRE 01/08/2015 31/12/2016

18 1500000001932 RS KASIH IBU TABANAN JL. FLAMBOYAN NO 9 BR TEGAL BELODAN TABANAN 82111 5003737 PER/20/082015 RS.TRAUMA

CENTRE 01/08/2015 31/12/2016

19 1400000000484 RS SURYA HUSADHA DENPASAR

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

08/01/2016 31/12/2016

20 1400000000483 RS SURYA HUSADHA UBUNG

JL COKROAMINOTO NO 356 PER/01/2016 RS.TRAUMA CENTRE

08/01/2016 31/12/2016

21 1200000000017 RSU BHAKTI RAHAYU DENPASAR JL GATOT SUBROTO II NO 11 DENPASAR 430270 PUTU IVAN YUNATANA PER/12/112014 RS.TRAUMA

CENTRE 01/01/2015 31/10/2015

22 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

23 7-3771899883 RSU BHAKTI RAHAYU TABANAN

JL. BATUKARU NO.2, TUAKILANG, TABANAN

82111 (0361)810805

RSU BHAKTI RAHAYU TABANAN


14/06/2016 31/12/2018

24 7-3513643274 RSU KERTHA USADA JL CENDRAWASIH NO 5-7 SINGARAJA 81111 036226277 RSU KERTHA USADA PER/13/052016 RS.TRAUMA CENTRE

25/05/2016 31/12/2018

25 1400000000554 RSU PARAMA SIDHI JLN. AHMAD YANI NO. 171A SINGARAJA 32701 PER/06/012016RS.TRAUMA CENTRE 08/01/2016 31/12/2016

26 7-204036033RSU PURI RAHARJA DENPASAR JL WR SUPRATMAN NO 14 & 19 DENPASAR 80232

0361222013

RSU PURI RAHARJA DENPASAE PER/31/102015

RS.TRAUMA CENTRE 06/11/2015 31/12/2016

27 1500000000140 RSU SHANTI GRAHADSN TAMANSARI DESA SULANYAH SERIRIT SINGARAJA

94554PT MEKAR SHANTI GRAHA


01/02/2015 31/12/2015

28 7-3514466595 RSU SHANTI GRAHA SULANYAH BD TAMANSARI SERIRIT BULELENG

81153 036294554 RSU SHANTI GRAHA PER/12/052016 RS.TRAUMA CENTRE

25/05/2016 31/12/2018


Periode : 01/01/2015 s/d 31/10/2016


440 / 44607-11-201606:23:31



IKS


29 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

30 7-2919990413 RSUD BULELENG JL NGURAH RAI NO 30 SINGARAJA BULELENG 81111 036222046 RSUD BULELENG PER/09/032016 RS.TRAUMA

CENTRE 14/04/2016 28/02/2018

31 1500000000655 RSUD KABUPATEN BADUNGMANGUSADA

JL. RAYA KAPAL MENGWI, BADUNG 9006812 DR. AGUS BINTANG SURYADHI, M.KES.


01/06/2015 31/12/2016

32 1400000000506 RSUD NEGARA JL WIJAYA KUSUMA NO 17 NEGARA DR MADE DWIPAYANA, MPPM


11/08/2016 31/12/2018

33 1500000000654 RSUD WANGAYA JL. KARTINI NO.133 DENPASAR 222141 DR. SETIAWATI HARTAWAN,M.KES PER/14/042015 RS.TRAUMA

CENTRE 01/05/2015 31/12/2016

34 1400000000485 SILOAM HOSPITAL BALI JALAN SUNSET ROAD NO 818 KUTA 779900 PER/04/012016RS.TRAUMA CENTRE 08/01/2016 31/12/2016

KANTOR CABANG : X01- KANTOR CABANG KUPANG


IKS


1 7-2064672333KILNIK KUPANG GRAHA MEDIKA

JALAN BUNDARAN PU NOMOR 54C KUPANG 85111 85852420

PT. KUPANG GRAHA MEDIKA

PER/ 008/ 022016

RS.TRAUMA CENTRE 18/02/2016 17/02/2017

2 1100000000003PROF DR WZ JOHANNES KUPANG

JL M HOTTA NO 19PER/ 002/ 012015

RS.TRAUMA CENTRE

01/01/2015 31/12/2015

3 1100000000003 PROF DR WZ JOHANNES KUPANG

JL M HOTTA NO 19 PER/ 016/ 032016

RS.TRAUMA CENTRE

17/03/2016 15/03/2017


Periode : 01/01/2015 s/d 31/10/2016


441 / 44607-11-201606:23:31



IKS


4 1400000000288 RS BHAYANGKARA KUPANG JL NANGKA 84 KUPANG 85111 821999 POLRI / POLDA NTT PER/ 017/

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

5 1400000000288 RS BHAYANGKARA KUPANG JL NANGKA 84 KUPANG 85111 821999 POLRI / POLDA NTT PER/ 017/

102015RS.TRAUMA CENTRE 01/10/2015 30/09/2016

6 7-170855890 RS KARTINI KOTA KUPANG JALAN FRANS SEDA NO 17 KUPANG 85112 PT KARTINI MEDIKAL KUPANG

PER/ 018 /102015

RS.TRAUMA CENTRE

04/11/2015 30/09/2016

7 7-170855890 RS KARTINI KOTA KUPANG JALAN FRANS SEDA NO 17 KUPANG 85112 PT KARTINI MEDIKAL KUPANG


20/10/2016 31/12/2017

8 7-3100749143 RS ST CAROLUS BORROMEUS

JL. PROF. H.R KOROH KM 08, BELO, KUPANG 85146 00030530 YAYASAN ELISABETH

GRUYTERS05/PKS/RSCB/IV/2016

RS.TRAUMA CENTRE 27/04/2016 18/04/2017

9 1400000000090RS TNI AL SAMUEL J MOEDAKUPANG

JL YOS SUDARSO NO. 5 OSMOK ALAK KUPANG

085242475035 TNI AL PER/15/ 062015

RS.TRAUMA CENTRE 01/06/2015 31/05/2016

10 1400000000090 RS TNI AL SAMUEL J MOEDAKUPANG

JL YOS SUDARSO NO. 5 OSMOK ALAK KUPANG

085242475035

TNI AL PER/021/062016 RS.TRAUMA CENTRE

30/06/2016 01/06/2017

11 1500000000469 RST WIRASAKTI KOTA KUPANG

JALAN MOH HATTA NOMOR 11 KUPANG PER/ 018/ 042016

RS.TRAUMA CENTRE

27/04/2016 18/04/2017

12 1500000000469RST WIRASAKTI KOTA KUPANG JALAN MOH HATTA NOMOR 11 KUPANG PER/ 09/ 042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

13 1500000000470RSUD BA'A KABUPATEN ROTE NDAO JALAN BUSALANGGA BA'A PER/ 08/ 042015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

14 1400000000417RSUD DR TC HILLERS MAUMERE

JALAN WAIRKLAU MAUMERE 2426133PER/ 005/ 012016

RS.TRAUMA CENTRE

28/01/2016 31/12/2016

15 1500000000064 RSUD KAB SABU RAIJUA JALAN TRANS SEBA BOLOU KM 7 MENIA SABU


01/01/2015 31/12/2015


Periode : 01/01/2015 s/d 31/10/2016


442 / 44607-11-201606:23:31



IKS


16 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

17 1500000000582 RSUD KEFAMENANU KAB TTU JALAN LERJEN SOEPRAPTO KEFAMENANU PER/ 010 /

042015RS.TRAUMA CENTRE 01/04/2015 31/03/2016

18 1400000000565 RSUD MGR GABRIEL MANEKATAMBUA

JALAN DR SOETOMO NO 02 ATAMBUA 21016 PER/ 003/ 012016

RS.TRAUMA CENTRE

28/01/2016 31/12/2016

19 1400000000418 RSUD NAIBONAT KABUPATEN KUPANG

JALAN TIMOR TAYA KM 37 OELAMASI 85223 PER/ 019/ 102015

RS.TRAUMA CENTRE

17/12/2015 31/10/2016

20 1400000000418 RSUD NAIBONAT KABUPATEN KUPANG JALAN TIMOR TAYA KM 37 OELAMASI 85223 PER/ 019/

102015RS.TRAUMA CENTRE 01/11/2015

21 1500000000394 RSUD SOE KABUPATEN TTS JLN CENDANA SOE PER/07/032015RS.TRAUMA CENTRE 01/03/2015 28/02/2016

22 1400000000394 RSUD UMBU RARA MEHA WAINGAPU

JALAN ADAM MALIK NO 54 WAINGAPU 61302 PER/ 007/ 012016

RS.TRAUMA CENTRE

01/02/2016 30/01/2017

23 1500000001987 RUMAH SAKIT KARTINI KOTA KUPANG

JALAN FRANS SEDA NOMOR 17 KUPANG 85141 PER / 018 /102015

RS.TRAUMA CENTRE

01/10/2015 30/09/2016

24 7-2537666813RUMAH SAKIT KATHOLIK MARIANUM HALILALUK

JALAN PAROKI ROH KUDUS HALILALUK ATAMBUA 85713 YAYASAN MARIA VIRGO

PER/ 014/ 032016

RS.TRAUMA CENTRE 17/03/2016 15/03/2017

25 7-2240138189RUMAH SAKIT KRISTEN LINDI MARA JALAN PROF WZ YOHANNES NOMOR 06 87111 YUMERKRIS PER 010/ 022016

RS.TRAUMA CENTRE 24/02/2016 24/02/2017

26 1500000000119RUMAH SAKIT PANGKALAN TNI AU EL TARI

JL ADI SUCIPTO NO 2 KUPANG 3838123 TNI AU PER/04/012015RS.TRAUMA CENTRE

01/01/2015 31/12/2015

27 1500000000119 RUMAH SAKIT PANGKALAN TNI AU EL TARI

JL ADI SUCIPTO NO 2 KUPANG 3838123 TNI AU PER/ 004/ 012016

RS.TRAUMA CENTRE

28/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


443 / 44607-11-201606:23:31



IKS


28 1400000000543 RUMAH SAKIT PENYANGGA PERBATASAN BETUN

JALAN SUKABIHANAWA DESA KAMANASAMALAKA TENGAH PER/ 09/ 022016 RS.TRAUMA

CENTRE 15/02/2016 09/02/2017

29 7-2556506581 RUMAH SAKIT UMUM SILOAM JALAN RW MONGINSISI FATULULI OEBOBO 85111 85309000 PT KRISOLIS JAYA

MANDIRIPER/ 015/ 032016

RS.TRAUMA CENTRE 17/03/2016 16/03/2017

30 7-1708103837 SILOAM HOSPITALS LABUAN BAJO

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

86754 PT LINTAS BUANA JAYA PER/ 006/ 012016

RS.TRAUMA CENTRE

29/01/2016 29/01/2017

31 1500000000438UPT PELATIHAN TENAGA KERJA DINAS NAKERTRANS PROVINSI NTT

JALAN THAMRIN NO 03 KAYU PUTIH 833270 PER/ 05/ 032015 RS.TRAUMA CENTRE

01/03/2015 29/02/2016

32 1500000000438UPT PELATIHAN TENAGA KERJA DINAS NAKERTRANS PROVINSI NTT

JALAN THAMRIN NO 03 KAYU PUTIH 833270 PER/ 013 / 032016

RS.TRAUMA CENTRE 17/03/2016 15/03/2017

KANTOR CABANG : X03- KANTOR CABANG MATARAM


IKS


1 1500000000500 BLK MATARAM JL TGH HAMBALI NO. 2 MATARAM 623443DINAS TENAGA KERJA & TRANSMIGRASI PROVINSI NTB

/464/NAKERTRANS/III/2015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

2 1400000000390RS BHAYANGKARA MATARAM JL. LANGKO NO 64 MATARAM 83117 629149

DRG MUHAMMAD ZAKIRSH,MH PER/19/102015

RS.TRAUMA CENTRE 03/12/2015 31/12/2016

3 7-2053953083RS H.L. MANAMBAI ABDULKADIR

JL LINTAS SUMBAWA-BIMA KM 5 KAB SUMBAWA BESAR

84311 803801361DR H SYAMSUL HIDAYAT


18/02/2016 31/12/2016

4 1400000000429 RS HARAPAN KELUARGA JL AHMAD YANI NO 9, SELAGALAS, MATARAM

83117 6177000 DR JEFFRY SUGIANTO PER/20/112015 RS.TRAUMA CENTRE

03/12/2015 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


444 / 44607-11-201606:23:31



IKS


5 1400000000276 RSU PROVINSI NTB JALAN PEJANGGIK NO 6 MATARAM 621345 RSU PROVINSI NTB PER/17/082015 RS.TRAUMA CENTRE 03/12/2015 31/12/2015

6 1500000000061RSUD ASY-SYIFA' KABUPATEN SUMBAWA BARAT

JALAN UNDRU NO 6 KEC TALIWANG 84455 8281057 DR HJ DWIWIDIA MERTASARI PER/02/012015 RS.TRAUMA

CENTRE 02/01/2015 31/12/2015

7 1500000000061RSUD ASY-SYIFA' KABUPATEN SUMBAWA BARAT

JALAN UNDRU NO 6 KEC TALIWANG 84455 8281057 DR HJ DWIWIDIA MERTASARI


09/05/2016 31/12/2016

8 1400000000433 RSUD BIMA JL LANGSAT NO 1 RABA KOTA BIMA 43142 DRG H IHSAN PER/25/112015 RS.TRAUMA CENTRE

29/03/2016 31/12/2016

9 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

10 1400000000513 RSUD KABUPATEN DOMPU JL KESEHATAN NO 01 KAB DOMPU 21411 DR H AHMAD FAISAL PER/05/012016RS.TRAUMA CENTRE 09/05/2016 31/12/2016

11 1400000000396 RSUD KABUPATEN LOMBOKUTARA

JL RAYA TANJUNG - BAYAN, KEC TANJUNG 6147758 DR H LALU BAHARUDIN PER/24/102015 RS.TRAUMA CENTRE

29/03/2016 31/12/2016

12 1400000000111 RSUD KOTA MATARAM JL BUNG KARNO NO 3 PAGUTAN MATARAM

RSUD KOTA MATARAM PER/04/012015 RS.TRAUMA CENTRE

02/01/2015 31/12/2015

13 7-2043435163 RSUD KOTA MATARAMJALAN BUNG KARNO NO 3 PAGUTAN MATARAM 83117 907545167

DR H.L. HERMAN MAHAPUTRA MKES PER/02/012016

RS.TRAUMA CENTRE 14/04/2016 31/12/2016

14 1400000000259 RSUD PATUT PATUH PATJU JL H L ANGGRAT BA NO 2 KEC GERUNG 681321RSUD PATUT PATUH PATJU PER/06/012016

RS.TRAUMA CENTRE 09/05/2016 31/12/2016

15 7-2055355604 RSUD PRAYAJL H LALU HASYIM NO 02 KEL TIWU GALI KEC PRAYA KAB LOMBOK TENGAH

83511 75786619 DR MUZAKIR LANGKIR PER/22/112015RS.TRAUMA CENTRE

18/02/2016 31/12/2016

16 7-2094061443 RSUD PROVINSI NTB JL PRABURANGKASARI DASAN CERMEN MATARAM

83117 0818547005

DR H MAWARDI HAMRY MPPM


23/02/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


445 / 44607-11-201606:23:31



IKS


17 1400000000110 RSUD SUMBAWA JL GARUDA NO 5 SUMBAWA BESAR 21929 RSUD SUMBAWA PER/03/012015 RS.TRAUMA CENTRE 01/01/2015 31/12/2015

18 7-2306934144 RSUD SUMBAWA JL GARUDA NO 5 SUMBAWA BESAR 84311 909048313 DR SELVI PER/04/012016 RS.TRAUMA CENTRE 14/04/2016 31/12/2016

KANTOR CABANG : X04- KANTOR CABANG BALI GIANYAR


IKS


1 1500000000842DINAS TENAGA KERJA DAN TRANSMIGRASI KAB KARANGASEM

JL AHMAD YANI NO 29 AMLAPURA 8421188PER/1001/032015

RS.TRAUMA CENTRE 01/04/2015 31/03/2016

2 1500000000114 KLINIK PENTA MEDIKA JL. RAYA MANGGIS 88 41909 DR. A A GEDE YUDI YUNARDHANA PUTRA


22/01/2016 31/12/2016

3 1500000000114 KLINIK PENTA MEDIKA JL. RAYA MANGGIS 88 41909 DR. A A GEDE YUDI YUNARDHANA PUTRA


01/01/2015 31/12/2015

4 1400000000453 RSUD BANGLI JL. BRIGJEN NGURAH RAI NO. 99X 91002 PER/006/112015RS.TRAUMA CENTRE 16/12/2015 31/12/2016

5 1400000000395 RSUD KARANGASEM JL. I GUSTI NGURAH RAI AMLAPURA 21470 PER/004/012016RS.TRAUMA CENTRE 29/03/2016 31/12/2016

6 1400000000395 RSUD KARANGASEM JL. I GUSTI NGURAH RAI AMLAPURA 21470 PER/005/102015RS.TRAUMA CENTRE

01/10/2015 31/12/2015

7 1400000000473 RSUD KLUNGKUNG JL. FLAMBOYAN NO 40 SEMARAPURA 21172 PER/005/012016 RS.TRAUMA CENTRE

22/01/2016 31/12/2016


Periode : 01/01/2015 s/d 31/10/2016


446 / 44607-11-201606:23:31



IKS


8 1400000000321 RSUD SANJIWANI GIANYAR JL. CIUNG WANARA NO. 2 943049 PER/004/092015 RS.TRAUMA CENTRE 01/09/2015 31/12/2015

9 1400000000321 RSUD SANJIWANI GIANYAR JL. CIUNG WANARA NO. 2 943049 PER/003/012016 RS.TRAUMA CENTRE 22/01/2016 31/12/2017

10 1500000000724 RUMAH SAKIT ARI ÇANTI JL. RAYA MAS UBUD 976508 DR. I WAYAN ARYAWAN PER/009/042016 RS.TRAUMA CENTRE

08/04/2016 31/03/2017

11 1500000000724 RUMAH SAKIT ARI ÇANTI JL. RAYA MAS UBUD 976508 DR. I WAYAN ARYAWAN PER/010/042015 RS.TRAUMA CENTRE

01/04/2015 31/03/2016

12 7-463005405 RUMAH SAKIT BALIMÉD KARANGASEM

JALAN NENAS, KECICANG, BEBANDEM, KARANGASEM 80811 DR. I NENGAH

SURANTEN PER/005/112015 RS.TRAUMA CENTRE 19/11/2015 31/12/2016

13 7-3047982743RUMAH SAKIT JIWA PROVINSI BALI JL. KUSUMA YUDHA NO 29 BANGLI 80611 036691073

DR. GEDE BAGUS DARMAYASA, M.REPRO PER/010/042016

RS.TRAUMA CENTRE 25/04/2016 31/12/2017

14 7-4401502383 RUMAH SAKIT UMUM FAMILI HUSADA

JL. ASTINA TIMUR NO 8A SAMPLANGAN 80511 03618493344

DR. MADE KOEN VIRAWAN, MARS


19/08/2016 31/12/2017

15 1200000000003 RUMAH SAKIT UMUM GANESHA

JL RAYA CELUK,SUKAWATI 298233 DR. GUSTI PUTU DARMIKA.S.KED


18/01/2016 31/12/2016

16 1200000000003RUMAH SAKIT UMUM GANESHA JL RAYA CELUK,SUKAWATI 298233

DR. GUSTI PUTU DARMIKA.S.KED PER/002/012015

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

17 1400000000256 YAGYA DASA KLINIKJL RAYA SENGKIDU DS SENGKIDU KEC MANGGIS 41378

DR NI WAYAN PUTU SUATI PER/011/072016

RS.TRAUMA CENTRE 01/07/2016 31/12/2017

18 1400000000256 YAGYA DASA KLINIKJL RAYA SENGKIDU DS SENGKIDU KEC MANGGIS

41378DR NI WAYAN PUTU SUATI


01/07/2015 30/06/2016

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