DAFTAR JEJARING TRAUMA CENTER DAN FASILITAS KERJASAMA BPJS KETENAGAKERJAAN

Halaman : Tanggal Cetak : Waktu Cetak :

DAFTAR JEJARING TRAUMA CENTER DAN FASILITAS KERJASAMA BPJS KETENAGAKERJAAN

1 / 151 16-05-2016 07:59:01

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

NO

:

KODE PROVIDER

001- KANTOR CABANG TERNATE

NAMA PROVIDER

ALAMAT

1

1400000000043

DR. TUTHANURANII NACHRAWY, M. KES

JL. PAHLAWAN REVOLUSI

2

06574

RUMAH SAKIT ISLAM BINA WARGA TERNATE

JLN.PEMUDA NO.131 KOTA TERNATE

3

1500000000035

RUMAH SAKIT MEDIKA HARIFALM

KEL KOTA BARU KOTA TERNATE

4

08016

RUMAH SAKIT UMUM DAERAH LABUHA

JL. RAYA LABUHA BABANG

KANTOR CABANG

NO

1

KODE PROVIDER

1

RSUD KAREL SATSUITUBUN LANGGUR

KODE PROVIDER

1500000000503

MA11222I

:

IKS TELEPON

PIMPINAN NO IKS

3121623

21118

TIPE IKS

AWAL IKS

AKHIR IKS

DR.TUTHANURANI NACHRAWY

PER/004/032016

RS.TRAUMA CENTRE

31/03/2016

31/12/2018

YAYASAN ISLAM BINA WARGA

PER/002/012016

RS.TRAUMA CENTRE

14/03/2016

31/12/2016

DR.AZIS MANAF SP.PD

PER/001/012016

RS.TRAUMA CENTRE

22/02/2016

31/12/2016

HJ. AISA BADARUNI S.KM, M.KES

PER/003/012016

RS.TRAUMA CENTRE

14/03/2016

31/12/2016

003- KOTA TUAL

NAMA PROVIDER

7-3193917369

KANTOR CABANG

NO

:

KODE POS

ALAMAT

JL. MERDEKA RAYA NO. 03 OHOIJANG LANGGUR

KODE POS

97611

IKS TELEPON

PIMPINAN NO IKS

21612/2161 3

DR. K. NOTANUBUN, M. KES

199/631/RSUD/K S/V/2016

TIPE IKS

AWAL IKS

RS.TRAUMA CENTRE

09/05/2016

AKHIR IKS 06/04/2018

100- KANTOR CABANG SORONG

NAMA PROVIDER

BALAI LATIHAN KERJA INDUSTRI (BLKI) SORONG

ALAMAT

JL BASUKI RAHMAT KM 9.5 KOTA SORONG

KODE POS

IKS TELEPON

PIMPINAN NO IKS

322549

YULIANTI MATANDUNG,S.SOS,MM

PER/008/042016


TIPE IKS RS.TRAUMA CENTRE

AWAL IKS 25/04/2016


SM0480



2 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

2

1400000000012

KLINIK MAJU BERSAMA (KLINIK-TC)

JL BASUKI RAHMAT KM 11 (DEPAN BATALION)

3

1400000000555

KLINIK MAJU BERSAMA II AIMAS (KTC)

JL WORTEL AIMAS UNIT 2 KAB SORONG

4

04658

RS MUTIARA

5

1400000000567

6

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

DR LIDIA KURNIAWAN

PER/003/032016

RS.TRAUMA CENTRE

01/03/2016

28/02/2017

13351490

DR. GINDAR SITEPU

PER/044/122015

RS.TRAUMA CENTRE

05/01/2016

30/11/2016

JL MALEO NO 2 SORONG

095132743 3

DR HJ PAHIMAH/ISKANDAR

PER/001/012016

RS.TRAUMA CENTRE

05/01/2016

31/12/2016

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

1400000000022

RSAL DR OETOYO (RS TC)

JLN JEND AHMAD YANI

PER/002/032016

RS.TRAUMA CENTRE

27/04/2016

28/02/2017

7

1400000000539

RSUD KAB FAK-FAK (RSTC)

JL. JENDRAL SUDIRMAN KAB FAK-FAK

44671705

PER/02/122015

RS.TRAUMA CENTRE

12/05/2016

30/11/2016

8

1400000000408

RSUD KAB RAJA AMPAT (RSTC)

JL DISTRIK WAISAI

44717931

PER/043/112015

RS.TRAUMA CENTRE

01/02/2016

31/10/2016

9

1400000000034

RSUD KAB SORONG (RSTC)

JL KESEHATAN NO 36

321763

PER/004/042016

RS.TRAUMA CENTRE

08/04/2016

31/03/2017

10

1400000000457

RSUD MANOKWARI (RSTC)

JL BHAYANGKARA NO 1 MANOKWARI

44110391

PER/010/112014

RS.TRAUMA CENTRE

07/03/2016

31/10/2015

11

1400000000457

RSUD MANOKWARI (RSTC)

JL BHAYANGKARA NO 1 MANOKWARI

44110391

PER/007/112015

RS.TRAUMA CENTRE

07/03/2016

31/10/2016

12

02442

RSUD SORONG

JL YOS SUDARSO SORONG

321580

PER/004/042016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

KANTOR CABANG

MA11222I

:

101- KANTOR CABANG JAYAPURA


SM0480



3 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

1

1500000000457

KLINIK PRATAMA BUNDA HATI KUDUS

JL. RAYA MANDALA NO. 26 MERAUKE

2

1500000000524

RS BUNDA PENGHARAPAN MERAUKE

3

1500000000081

4

1400000000716

KANTOR CABANG

NO

:

KODE PROVIDER

RS BUNDA PENGHARAPAN MERAUKE

PER/02/042016

RS.TRAUMA CENTRE

13/04/2016

31/12/2017

RS MARTHEN INDEY

JL. DIPONEGORO NO. 27 GURABESI

RSMI JAYAPURA

PER/18/122015

RS.TRAUMA CENTRE

14/01/2016

31/12/2016

RSAL DR. SOEDIBJO SARDADI

JL. AMPHIBI NO. 1 HAMADI

RSAL DR. SOEDIBJO SARDADI

PER/19/122015

RS.TRAUMA CENTRE

14/01/2016

31/12/2016

44603533

522958

102- KANTOR CABANG MIMIKA

ALAMAT

1500000000345

RUMAH SAKIT UMUM DAERAH (RSUD) MIMIKA

JLN YOS SUDARSO NAWARIPI

MA11222I

AKHIR IKS

JL. ANGKASA I KELAPA LIMA MERAUKE

2

08469

AWAL IKS

31/12/2017

JLN BUDI UTOMO NO. 50

1

TIPE IKS

13/04/2016

KLINIK MAHAFIDIN MEDICAL CARE (MMC)

KODE PROVIDER

NO IKS

RS.TRAUMA CENTRE

1400000000460

NO

PIMPINAN

PER/03/042016

NAMA PROVIDER

:

IKS TELEPON

KLINIK PRATAMA BUNDA HATI KUDUS

1

KANTOR CABANG

KODE POS

KODE POS

99910

IKS TELEPON

PIMPINAN NO IKS

09013125200

TIPE IKS

AWAL IKS

AKHIR IKS

IWAN ANWAR SH

PER/05/052016

RS.TRAUMA CENTRE

09/05/2016

31/12/2016

RSUD MIMIKA

PER/04/042016

RS.TRAUMA CENTRE

01/05/2016

31/12/2016

A00- KANTOR CABANG LHOKSEUMAWE

NAMA PROVIDER

KLINIK LHOKSEUMAWE HUSADA

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

KODE POS

IKS TELEPON

PIMPINAN NO IKS

081396697 999

DR. HJ. KIKIE INDRIATY

PER/04/032016



AWAL IKS 24/03/2016


SM0480



4 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

2

1500000000229

KLINIK VINCA ROSEA LHOKSEUMAWE

JL. DARUSSALAM NO. 36 GAMPONG JAWA BARU

AZHARI

PER/06/052016

RS.TRAUMA CENTRE

02/05/2016

31/12/2016

3

1500000000225

KLINIK VINCA ROSEA TAKENGON

JLN. ABDUL WAHAB KP. SIMPANG EMPAT KECAMATAN BEBESAN

AZHARI

PER/07/052016

RS.TRAUMA CENTRE

02/05/2016

31/12/2016

4

1500000000630

PUSKESMAS PAYA BAKONG

JL TGK SYIK PAYA BAKONG CEUMPEUDAK KAB ACEH UTARA

DR. WAHYUDI HIDAYAT

PER/10/052016

RS.TRAUMA CENTRE

10/05/2016

31/12/2016

5

1500000000127

RUMAH SAKIT AVICENNA BIREUEN

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

DR.FAISAL,SP.OG

PER/02/022016

RS.TRAUMA CENTRE

24/02/2016

31/12/2016

6

7-2060022073

RUMAH SAKIT PMI ACEH UTARA

JALAN SAMUDERA GAMPONG KAMPUNG JAWA KEC BANDA SAKTI

DR FERIANTO

PER/01/022016

RS.TRAUMA CENTRE

17/02/2016

31/12/2016

7

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

8

1400000000322

RUMAH 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

9

1400000000691

RUMAH SAKIT UMUM BUNGA MELATI

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

44821

DR.TAUFIQ A.R

PER/03/022016

RS.TRAUMA CENTRE

26/02/2016

31/12/2016

KANTOR CABANG

NO

1

KODE PROVIDER

1500000000167

MA11222I

:

22887

24352

A01- KANTOR CABANG BANDA ACEH

NAMA PROVIDER

BLUD RS IBU DAN ANAK ACEH

ALAMAT

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

KODE POS

IKS TELEPON

PIMPINAN NO IKS

637433

PEMERINTAH ACEH

PER/20/022016



AWAL IKS 03/03/2016


SM0480



5 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

2

1400000000569

CEMPAKA LIMA

JLN. TGK. H. M. DAUD BEUREUEH NO.78 A BEURAWE KEC.KUTA ALAM KOTA BANDA ACEH

3

1500000000056

KLINIK AA MEDICAL

4

1400000000566

5

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

HJ. KARTINI.N.I

PER/38/122015

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

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

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

1400000000670

KLINIK BUNDA

JL.BANDA ACEH-MEDAN NO.1 GAMPONG BARO JAMAN KEC. MUTIARA

ITA MUTIA

PER/17/022016

RS.TRAUMA CENTRE

22/02/2016

31/12/2016

6

1500000000122

KLINIK CAHAYA BUNDA

JL. KEBUN RAJA GP. IE MASEN KEC. ULEE KARENG BATA KOTA BANDA ACEH

DR.BUDI PERMANA

PER/08/022016

RS.TRAUMA CENTRE

10/02/2016

31/12/2016

7

1500000000055

KLINIK KELUARGA ASMAUL HUSNA

GAMPONG ULEE GLE KEC BANDAR DUA

SAIFUL BAHRI IDRIS

PER/04/012016

RS.TRAUMA CENTRE

27/01/2016

31/12/2016

8

1500000000153

KLINIK KIMIA FARMA

JL. PERDAGANGAN NO. 1 KOTA SIGLI KEC. KOTA SIGLI KAB. PIDIE

M. BAGUS ANDREAS TAUFANI, S.FARM, APT

PER/11/022016

RS.TRAUMA CENTRE

10/02/2016

31/12/2016

9

1500000000019

KLINIK LATIFAH

JL. SOEKARNO -HATTA N0.04 DSN. MELATI GP. GAROT KEC. DARUL IMARAH KAB. ACEH BESAR

SISKA ARSYAD, S.KED

PER/19/022016

RS.TRAUMA CENTRE

02/03/2016

31/12/2016

10

1500000001919

KLINIK MITRA MEDISTRA

JL. RESIDEN DANUBROTO GP. LAMLAGANG KEC. BANDA RAYA

23111

AZIZURRAHMAN, SKM,MM

PER/10/022016

RS.TRAUMA CENTRE

10/02/2016

31/12/2016

11

7-1676350253

KLINIK RANUP PEUNAWA MEDIKA

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

23352

CAPT. FADLI, SE, M.MAR

PER/05/012016

RS.TRAUMA CENTRE

01/02/2016

31/12/2016

12

1400000000677

KLINIK RAWAT INAP MINA

JL.LAKSAMANA MALAHAYATI KM.7 GP.BAET KEC.BAITUSSALAM KAB. ACEH BESAR

DR. RAHMI

PER/13/022016

RS.TRAUMA CENTRE

10/02/2016

31/12/2016

13

1400000000673

KLINIK SIWAH MEDIKA CENTER

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

LYDIA SEPTA DESIYANA, M.SI, APT

PER/12/022016

RS.TRAUMA CENTRE

10/02/2016

31/12/2016

MA11222I

33345

21536

72303666


SM0480



6 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

14

1500000000242

KLINIK UMMI AISYAH

JL. PERDAGANGAN GAMPONG KUTA BARAT KOTA SABANG

15

1400000000191

RS CITRA HUSADA SIGLI

JL. PROF MAJID IBRAHIM LAMPEUDEU BAROH KOTA SIGLI KABUPATEN PIDIE

16

1400000000073

RS HARAPAN BUNDA

17

1400000000073

18

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

MINALTIWATI, AMD.KEB

PER/18/022016

RS.TRAUMA CENTRE

27/02/2016

31/12/2016

96707970

DR JULIANA SP AK

PER/28/092015

RS.TRAUMA CENTRE

12/01/2016

01/09/2016

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

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

1400000000692

RSUD KABUPATEN PIDIE JAYA

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

PER/09/022016

RS.TRAUMA CENTRE

10/02/2016

31/12/2016

19

7-2017798742

RSUD ZAINOEL ABIDIN

JL. TGK H.M DAUD BEUREUEUH NO 108 BANDA ACEH

23121

60668923

DR. FACHRUL JAMAL, SP. AN. KIC

PER/16/022016

RS.TRAUMA CENTRE

16/02/2016

31/12/2016

20

7-2017798742

RSUD ZAINOEL ABIDIN

JL. TGK H.M DAUD BEUREUEUH NO 108 BANDA ACEH

23121

60668923

DR. FACHRUL JAMAL, SP. AN. KIC

PER/16/022016

RS.TRAUMA CENTRE

15/02/2016

31/12/2018

21

1500000000093

RUMAH SAKIT IBNU SINA

JL B. ACEH-MEDAN KM 25,5 DESA SINYEU KEC INDRAPURI

085238105 999

DIANA PURWANI

PER/36//12/2015

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

22

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

23

1400000000570

RUMAH SAKIT U'BUDIYAH

7555750

PT. CAISARIO ROYAL PRATAMA

PER/35/122015

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

24

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

25

1500000000302

RUMAH SAKIT UMUM BULAN SABIT MERAH

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

HERI RISWANDI

PER/21/022016

RS.TRAUMA CENTRE

03/03/2016

31/12/2016

MA11222I


SM0480



7 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

26

1500000000166

RUMKIIT BHAYANGKARA

JL. CUT NYAK DHIEN NO. 1 KEL. LAMTEUMEN

27

7-2832361743

RUMKIT TK II ISKANDAR MUDA BANDA ACEH

JL T. HAMZAH BENDAHARA NO 1 KOTA BANDA ACEH

KANTOR CABANG

NO

KODE PROVIDER

:

KODE POS

IKS TELEPON

PIMPINAN NO IKS

41470

23121

TIPE IKS

AWAL IKS

AKHIR IKS

KEPOLISIAN REPUBLIK INDONESIA

PER/22/032016

RS.TRAUMA CENTRE

07/04/2016

31/12/2016

KEENTRIAN PERTAHANAN RI

PER/24/042016

RS.TRAUMA CENTRE

07/04/2016

31/12/2016

A02- KANTOR CABANG LANGSA

NAMA PROVIDER

ALAMAT

1

1400000000546

DR. SYARIFAH RINA MARLINA

JL. H AGUSSALIM NO. 20 KAMPUNG BLANG LANGSA KOTA

2

7-2520482973

KLINIK BAITU SSYIFA

DSN KUTA DESA KEUDE PEUREULAK KEC PEUREULAK ACEH TIMUR

3

1400000000552

KLINIK BINA HUSADA

JL. T. CHIK DITIRO NO. 3 GAMPONG PAYA BUJOK TUNONG LANGSA BARO

4

1500000000037

PUSKESMAS BANDAR PUSAKA

5

1500000000398

6

7

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

DR. SYARIFAH RINA MARLINA

PER/02/012016

RS.TRAUMA CENTRE

21/01/2016

31/12/2016

ZULFIKAR, S.KEP

PER/824/032016

RS.TRAUMA CENTRE

15/03/2016

31/12/2016

085336187 3663

DR H SYAFRIRUDDIN, MM

PER/17/012016

RS.TRAUMA CENTRE

27/01/2016

31/12/2016

KECAMATAN BANDAR PUSAKA

085363910 858

SYAMSUDDIN, SKM

PER/04/012016

RS.TRAUMA CENTRE

21/01/2016

31/12/2017

PUSKESMAS LANGSA BARAT

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

23093

AYU ARTLINTA, SKM, M.KES

PER/21/012016

RS.TRAUMA CENTRE

10/03/2016

31/12/2016

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

1500000000522

PUSKESMAS LANGSA KOTA

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

DR. T CHIK M. IQBAL F

PER/23/012016

RS.TRAUMA CENTRE

10/03/2016

31/12/2016

MA11222I

20354

24454

69222267


SM0480



8 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

8

1500000000395

PUSKESMAS LANGSA LAMA

JL PENDIDIKAN DS MEURANDEH DAYA KEC LANGSA LAMA

NS. EDI SYAHPUTRA, S.KEP

PER/24/012016

RS.TRAUMA CENTRE

10/03/2016

31/12/2016

9

1500000000397

PUSKESMAS LANGSA TIMUR

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

DR. MAHLIDAYANTI

PER/25/012016

RS.TRAUMA CENTRE

07/03/2016

31/12/2016

10

1500000000040

PUSKESMAS SEKERAK

KECAMATAN SEKERAK

082168103 036

DR. ABDUL GAFUR

PER/03/012016

RS.TRAUMA CENTRE

21/01/2016

31/12/2017

11

1400000000340

RSU CUT MEUTIA

JL GARUDA NOMOR 1 KEBUN BARU KECAMATAN LANGSA BARO

23071

IR EDDY PURNOMO

PER/01/012016

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

12

1400000000340

RSU CUT MEUTIA

JL GARUDA NOMOR 1 KEBUN BARU KECAMATAN LANGSA BARO

23071

IR EDDY PURNOMO

PER/25/122015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

13

1400000000675

RSU CUT NYAK DHIEN

JL. T.M. BACHRUM NO 1 KOTA LANGSA

22228

DR YUSUF, MM

PER/01/012016

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

14

06730

RSUD ACEH TAMIANG

JL. KESEHATAN KECAMATAN KARANG BARU

31791

DR. ZUHEINI, M.KES

PER/20/012016

RS.TRAUMA CENTRE

14/03/2016

31/12/2016

15

7-2502904553

RSUD ACEH TAMIANG

JL KESEHATAN KEC KARANG BARU

PEMERINTAH KABUPATEN ACEH TAMIANG

PER/20/01/01201 6

RS.TRAUMA CENTRE

14/03/2016

31/12/2016

16

1500000000034

RSUD KOTA LANGSA

JALAN JEND. AHMAD YANI NO 1 KOTA LANGSA

22051

DR. HERMAN I

PER/18/012016

RS.TRAUMA CENTRE

27/01/2016

31/12/2016

17

1400000000674

RUMAH SAKIT UMUM UMMI

JL PROF A.MAJID IBRAHIM DUSUN SATRIA RT 02 SUNGAI PAUH KECAMATAN LANGSA BARAT

22886

DR. SAID MUHAMMAD FACHRIANSYAH

PER/19/012016

RS.TRAUMA CENTRE

15/02/2016

15/02/2017

18

1400000000674

RUMAH SAKIT UMUM UMMI

JL PROF A.MAJID IBRAHIM DUSUN SATRIA RT 02 SUNGAI PAUH KECAMATAN LANGSA BARAT

22886

DR. SAID MUHAMMAD FACHRIANSYAH

PER/19/012016

RS.TRAUMA CENTRE

16/02/2016

31/12/2016

KANTOR CABANG

MA11222I

:

24476

A03- KANTOR CABANG MEULABOH


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR 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/10/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

8

1500000000004

PUSKESMAS BEUTONG ATEUH

DESA KRUENG CUT

23672

MUHAMMAD DAUD, SKM

PER/39/122015

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

9

1500000000010

PUSKESMAS COT 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

1400000000630

PUSKESMAS 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/33/122015

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR 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

PER/30/122015

RS.TRAUMA CENTRE

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

1400000000621

PUSKESMAS 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

1500000000011

PUSKESMAS 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

1400000000617

PUSKESMAS 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

1400000000618

PUSKESMAS PEUREUMUE ACEH BARAT

JL. MEULABOH TUTUL, KEC. KAWAY XVI

23681

NILA TRISNA HD, AMK

PER/24/122015

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

24

1400000000623

PUSKESMAS PIR BATEE PUTEH ACEH BARAT

DS. PASI MALL, KEC. WOYLA BARAT

23682

CUT ELI YUSRA

PER/28/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

25

1400000000623

PUSKESMAS PIR BATEE PUTEH ACEH BARAT

DS. PASI MALL, KEC. WOYLA BARAT

23682

CUT ELI YUSRA

PER/32/122015

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

26

1500000000007

PUSKESMAS SIMPANG JAYA

JL. MBO-TPK TUAN, KEC. TADU RAYA

23661

SITI ROMLAH

PER/34/12215

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

27

1400000000648

PUSKESMAS SUAK RIBEE ACEH BARAT

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

23615

DR. SITI HAWANI

PER/28/122015

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

28

1500000000001

PUSKESMAS SUKA MULIA

JL. SEUNEUAM, KEC. DARUL MAKMUR

23662

JAMAL SUNGAEDI, SKM

PER/37/122015

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

29

1500000000016

PUSKESMAS TANGKEH

DS. TANGKEH, KEC. WOYLA TIMUR

23682

ADNEN AR, AMK

PER/35/122015

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

30

1500000000009

PUSKESMAS UJONG FATIHAH

DS. BLANG MUKO, KEC. KUALA

23661

CUT NIH

PER/38/122015

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

31

1500000000014

PUSKESMAS UTEUN PULO

DS. BLANG PANYANG, KEC. SEUNANGAN TIMUR

23671

HJ. YUSNIDAR

PER/36/122015

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

32

1400000000624

PUSKESMAS WOYLA ACEH BARAT

DS. KUALA BHEE, KEC. WOYLA

23654

YESWARDI, SKM

PER/29/122015

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

33

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

34

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

35

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

36

1500000000123

RSUD KOTA SUBULUSSALAM

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

62731700

PEMKOT SUBULUSSALAM

PER/15/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

37

1400000000602

RSUD TEUKU UMAR

JLN. GUNONG ALI LR. PMI NO.1 CALANG KEC. KRUENG SABEE

38

1500000000015

RSUD TEUNGKU PEUKAN

BLANG PIDIE,ACEH BARAT DAYA

39

1400000000614

RUMAH SAKIT TINGKAT IV IM 07.02 MEULABOH

JL. MERAH PUTIH GAMPONG SUAK INDRAPURI KEC. JOHAN PAHLAWAN

KANTOR CABANG

NO

KODE PROVIDER

:

KODE POS

23654

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

2210322

DR. SUZANNA OCTIVA, SP.KJ

PER/06/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

92522

DARUSMAN, M.KES (MMR)

PER/11/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

KAPTEM CKM DR. TEGUH ISMANTO,SP.AN

PER/16/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

B00- KANTOR CABANG MEDAN KOTA

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1400000000127

BP HARAPAN BUNDA

JL. BRIGJEND ZEIN HAMID NO 39 TITI KUNING

7852636

NETTY BARITA, SE

PER/01/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

2

1400000000127

BP HARAPAN BUNDA

JL. BRIGJEND ZEIN HAMID NO 39 TITI KUNING

7852636

NETTY BARITA, SE

PER/13/122015

RS.TRAUMA CENTRE

05/01/2016

31/12/2016

3

1500000000065

BP HARAPAN BUNDA 1

JL BALAI DESA NO 7 MEDAN POLONIA

6504129

NETTY BARITA,SE

PER/07/122015

RS.TRAUMA CENTRE

05/01/2016

31/12/2016

4

1500000000066

BP HARAPAN BUNDA 3

JL BRIGJEN KATAMSO NO 440 B

NETTY BARITA SE

PER/11/122015

RS.TRAUMA CENTRE

05/01/2016

31/12/2016

5

1500000000201

BP KURNIA

JL BINJAI KM 8.8 NO 11 KP LALANG MEDAN

850915

TAN ERFI

PER/18/022016

RS.TRAUMA CENTRE

18/02/2016

17/02/2017

6

1500000000201

BP KURNIA

JL BINJAI KM 8.8 NO 11 KP LALANG MEDAN

850915

TAN ERFI

PER/20/022016

RS.TRAUMA CENTRE

22/02/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

7

1500000000199

KLINIK ADISMA HUSADA DARUSSALAM

JL DARUSSALAM NO 5A

4153169

DR H SAYID BUDHI

PER/16/022016

RS.TRAUMA CENTRE

17/02/2016

31/01/2017

8

1500000000198

KLINIK ADISMA HUSADA TEMBUNG

JL BESAR MEDAN BATANG KUIS DSN XI TEMBUNG

7383103

DR SAYID BUDHI

PER/17/022016

RS.TRAUMA CENTRE

17/02/2016

31/01/2017

9

1500000000196

KLINIK AKSARA

JL AKSARA NO 120 MEDAN

97374384

TEGUH SUHARTO, SE

PER/23/022016

RS.TRAUMA CENTRE

24/02/2016

31/12/2016

10

1500000000206

KLINIK AVIATI 1

JL JAMIN GINTING NO 15 P BULAN MEDAN BARU

6103683

DRG AMETA PRIMASARI TARIGAN

PER/19/022016

RS.TRAUMA CENTRE

18/02/2016

31/01/2017

11

1500000000207

KLINIK AVIATI 3

JL JAMIN GINTING KM 8.5 KOMP DELTA NO 5 MEDAN TUNTUNGAN

3436450

DRG AMETA PRIMASARI TARIGAN

PER/21/022016

RS.TRAUMA CENTRE

22/02/2016

31/12/2016

12

1500000000203

KLINIK AZIZZI GATOT SUBROTO

JL JEND GATOT SUBROTO NO 333 MEDAN

4155528

DRS H RAZALI ROHIMUN

PER/26/022016

RS.TRAUMA CENTRE

24/02/2016

31/12/2016

13

1500000000202

KLINIK AZIZZI SUMARSONO

JL KAPT SUMARSONO NO 74 MEDAN

80030330

DR RIYADH IKHSAN

PER/25/022016

RS.TRAUMA CENTRE

24/02/2016

31/12/2016

14

1500000000194

KLINIK BERSAMA

JL JAMIN GINTING NO 502 P BULAN MEDAN

68272131

SAMPE REZEKI, SE

PER/24/022016

RS.TRAUMA CENTRE

24/02/2016

31/12/2016

15

1400000000126

KLINIK CITRA MEDIKA

JALAN SISINGAMANGARAJA NO 7 KM 4,5

7863134

DR YUDHA PRAYOGI

PER/02/122015

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

16

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

17

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

18

1500000001611

KLINIK MILLENIUM

JL KAPTEN MUSLIM NO 58C

63792195

SRI REZEKI SE

PER/27/022016

RS.TRAUMA CENTRE

01/03/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

19

1500000000197

KLINIK SENYUM JAYA ABADI

JL SETIABUDI NO 117 LINK V TG SARI

20

7-2460143493

MURNI TEGUH MEMORIAL HOSPITAL

JL JAWA NO 2 MEDAN

21

1500000000191

RS ADVENT MEDAN

22

1500000000190

23

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

8219006

DRG ERITA FLORA MANURUNG

PER/28/022016

RS.TRAUMA CENTRE

26/02/2016

31/12/2016

80501888

PT MURNI SADAR

PER/33/022016

RS.TRAUMA CENTRE

08/03/2016

31/12/2016

JL GATOT SUBROTO KM 4 MEDAN

4524875

YAYASAN RS ADVENT MEDAN

PER/16/022015

RS.TRAUMA CENTRE

26/02/2016

31/12/2016

RS BHAYANGKARA MEDAN

JL.KH WAHID HASYIM NO 1 MEDAN

8215990

POLDA SUMUT

PER/18/022015

RS.TRAUMA CENTRE

01/03/2016

31/12/2016

1500000000077

RS ESTOMIHI

JL SISINGAMANGARAJA NO 235

7861771

DR. M SAMOSIR, SP.PD

PER/09/122015

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

24

1400000000129

RS ISLAM MALAHAYATI

JL. PANGERAN DIPONEGORO NO 2-4

4518766

YAY RS MALAHAYATI

PER/03/122015

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

25

1500000000208

RS MARTHA FRISKA MULTATULI

JL MULTATULI KOMP MULTATULI INDAH NO 1

4149666

PT KARYA UTAMA SEHAT SEJAHTERA

PER/29/022016

RS.TRAUMA CENTRE

26/02/2016

31/12/2016

26

1500000000537

RS ROYAL PRIMA

JL AYAHANDA NO 68 A

88813182

YAYASAN PERG TINGGI PRIMA INDONESIA

PER/34/042016

RS.TRAUMA CENTRE

13/04/2016

31/12/2016

27

7-1446503984

RS SILOAM DHIRGA SURYA MEDAN

JL IMAM BONJOL NO 6 MEDAN

88881900

PT GRAMARI PRIMA NUSA

PER/15/012016

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

28

1500000000089

RSU BINA KASIH

JL JEND TB SIMATUPANG NO 148 SUNGGAL

8475111

YAYASAN BINA KASIH ABADI

PER/06/122015

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

29

1500000000091

RSU HERNA MEDAN

JL MOJOPAHIT NO 118A MEDAN

4510766

YAY TD PARDEDE FOUNDATION

PER/05/122015

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

30

1500000000624

RSU MATERNA

JL TEUKU UMAR NO 11 MEDAN

4514222

PT RUMAH SAKIT MATERNA

PER/35/042016

RS.TRAUMA CENTRE

25/04/2016

31/12/2016

MA11222I

20231

20111


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

31

1400000000124

RSU MITRA SEJATI

JL. AH NASUTION NO. 7 P. MASYHUR MEDAN

7875967

YAY. MITRA SEJATI

PER/04/122015

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

32

1500000000090

RSU PROF DR BOLONI

JL MONGONSIDI NO 11 MEDAN

4512687

YAY PROF DR BOLONI MARPAUNG

PER/10/122015

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

33

1500000000092

RSU SARI MUTIARA

JL KAPTEN MUSLIM NO 79 MEDAN

8451812

YAY SARI MUTIARA MEDAN

PER/08/122015

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

34

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

35

7-1375319217

RUMAH SAKIT SETIABUDI

JL MESJID NO 3 TANJUNG REJO MEDAN

DR OTMAN SIREGAR SPOT

PER/14/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

KANTOR CABANG

NO

KODE PROVIDER

:

20122

B01- KANTOR CABANG PEMATANGSIANTAR

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1400000000051

BPS SERASI

JL. JEND. A. YANI NO. 179K

28756

TAN ERFI

PER/34/TC/0120 16

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

2

1500000000249

KLINIK AINON

JL.MEDAN KM 4.5 NO.44

6205667

PAUL PARULIAN PURBA

PER/40/012016

RS.TRAUMA CENTRE

15/04/2016

28/02/2017

3

1500000000291

KLINIK KASIH

HUTA II BENDO NAGORI DUSUN ULU KEC. UJUNG PADANG KABUPAETN SIMALUNGUN

72908220

DR. SEVEN APRI H SAMOSIR

PER/41/052016

RS.TRAUMA CENTRE

10/05/2016

28/02/2017

4

1500000000291

KLINIK KASIH


72908220


PER/41/052016

RS.TRAUMA CENTRE

11/05/2016

31/12/2017

MA11222I


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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

5

1500000000291

KLINIK KASIH


72908220


PER/42/052016

RS.TRAUMA CENTRE

11/05/2016

31/12/2016

6

1500000000148

KLINIK KELUARGA

JL MEDAN NO.18 KM 4

28951

IR.AGUSTINUS SIANIPAR

PER/43/052016

RS.TRAUMA CENTRE

10/05/2016

31/12/2016

7

1500000000148

KLINIK KELUARGA

JL MEDAN NO.18 KM 4

28951


PER/42/062016

RS.TRAUMA CENTRE

10/05/2016

31/01/2017

8

1500000000148

KLINIK KELUARGA

JL MEDAN NO.18 KM 4

28951


PER/42/052016

RS.TRAUMA CENTRE

10/05/2016

31/12/2017

9

1400000000553

KLINIK MURNI

JL MELANTHON SIREGAR NO.206

6204978

APRIMO MP SIBARANI

PER/35/TC/0120 16

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

10

1400000000527

KLINIK PANDU

JL. SM. RAJA NO. 627 PERDAGANGAN

ANTONIUS

PER/36/TC/0120 16

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

11

1500000000237

KLINIK PUTERI KEMBAR

DALIL TANI NO.40

62164746

HERDIANA GULTOM

PER/43/052016

RS.TRAUMA CENTRE

10/05/2016

28/02/2017

12

1500000000237


DALIL TANI NO.40

62164746

HERDIANA GULTOM

PER/43/052016

RS.TRAUMA CENTRE

11/05/2016

31/12/2017

13

1500000000237


DALIL TANI NO.40

62164746

HERDIANA GULTOM

PER/44/052016

RS.TRAUMA CENTRE

10/05/2016

31/12/2016

14

1400000000534

KLINIK PUTRI

HUTA II NAGORI BAJA DOLOK KEC TANAH JAWA

76137512

SETI HARTATI AM.KEB

PER/38/TC/0120 16

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

15

1400000000544

KLINIK PUTRI

JL SISINGAMANGARAJA NO.20 KEL PARAPAT KEC GIRSANG SIPANGAN BOLON

6474965

DR.AMRAN SITUMORANG

PER/37/TC/0120 16

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

16

1500000000236

KLINIK RIDHO

JALAN SISINGAMANGARAJA NAGORI BALIMBINGAN KECAMATAN TANAH

64530224

DR. MENTI SIBURIAN

PER/44/052016

RS.TRAUMA CENTRE

10/05/2016

28/02/2017

MA11222I


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KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

17

1500000000236

KLINIK RIDHO


64530224

DR. MENTI SIBURIAN

PER/44/052016

RS.TRAUMA CENTRE

11/05/2016

31/12/2017

18

1500000000236

KLINIK RIDHO


64530224

DR. MENTI SIBURIAN

PER/45/052016

RS.TRAUMA CENTRE

10/05/2016

31/12/2016

19

1400000000050

KLINIK SIMA HUSADA

JL. KERTAS CETAK NO. 2A

60004795

ANDRE CHRISTIAN PARSAORAN SIMATUPANG

PER/39/TC/0120 16

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

20

1500000000103

KLINIK SUMBER SEHAT

JALAN KAPTEN TANDEAN BLOK D 8

6574736

DR.IRENE HARTONO

PER/46/2016

RS.TRAUMA CENTRE

10/05/2016

31/12/2016

21

1500000000103

KLINIK SUMBER SEHAT


6574736

DR.IRENE HARTONO

PER/45/052016

RS.TRAUMA CENTRE

11/05/2016

31/12/2017

22

1500000000103

KLINIK SUMBER SEHAT


6574736

DR.IRENE HARTONO

PER/45/052016

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/46/052016

RS.TRAUMA CENTRE

10/05/2016

31/01/2017

24

1400000000535

RSUD PERDAGANGAN

JL.RAJAMIN PURBA ,SH PERDAGANGAN

70324734

RSUD PERDAGANGAN

PER/29/TC/0120 16

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

25

1400000000676

RSUD PORSEA

JL. RAJA SIPAKKO NAPITUPULU KEC. PORSEA

61245547

PEMERINTAH KAB. TOBA SAMOSIR

PER/30/TC/0120 16

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

26

1400000000350

RSUD TUAN RONDAHAIM

KOMP PEMKAB SIMALUNGUN PEMATANG RAYA

331170

RSUD TUAN RONDAHAIM

PER/31/TC/0120 16

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

27

1400000000289

RUMAH SAKIT TENTARA

JL. GUNUNG SIMANUK MANUK NO. 6

434171

RUMAH SAKIT TENTARA

PER/28/TC/0120 16

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

28

1400000000545

RUMAH SAKIT UMUM DAERAH PARAPAT

JL.KOL TPR SINAGA KEC.GIRSANG SIPANGAN BOLON

62054053

RSUD PARAPAT

PER/32/TC/0120 16

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

MA11222I


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29

KODE PROVIDER

RUMAH SAKIT UMUM HKBP BALIGE

1400000000343

KANTOR CABANG

NO

NAMA PROVIDER

KODE PROVIDER

:

ALAMAT

KODE POS

JL GEREJA NO.17 BALIGE

IKS TELEPON

PIMPINAN NO IKS

21043

RSU HKBP BALIGE

PER/33/TC/0120 16

TIPE IKS

AWAL IKS

RS.TRAUMA CENTRE

13/01/2016


B02- KANTOR CABANG KISARAN

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1400000000608

BPS SARTIKA

JL. BESAR NEGERI LAMA KECAMATAN BILAH HILIR KABUPATEN LABUHAN BATU

081264339 055

MURSYID DALIMUNTE

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

2

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

3

1400000000109

KLINIK AMANAH

JL. SEI SILAU TIMUR KEC. BUNTU PANE

7352111

DR. NURHIMSYAH JUNEDI NASUTION

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

4

1400000000109

KLINIK AMANAH

JL. SEI SILAU TIMUR KEC. BUNTU PANE

7352111

DR. NURHIMSYAH JUNEDI NASUTION

PER/29/122015

RS.TRAUMA CENTRE

01/12/2016

29/12/2016

5

1400000000606

KLINIK AULIA

DUSUN III DESA SEI SUKA DERAS (KEBUN KOPI) KEC. SEI SUKA KAB. BATUBARA

085297350 468

RITA ADELINA

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

6

1400000000609

KLINIK CENTRAL MEDIKA

JL. ACCESS ROAD INALUM DESA PAKAM RAYA KECAMATAN MEDANG DERAS KABUPATEN BATU BARA

082368310 000

ZULKARNAEN

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

1400000000607

KLINIK DEWI SARTIKA

081264339 055

MURSYID DALIMUNTE

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

8

1400000000728

KLINIK ESTOMIHI

081262861 45

DR PATAR MT PANJAITAN

PER/30/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I

JL. BEDAGAI NO. 129 KOTAPINANG KECAMATAN KOTA PINANG KABUPATEN LABUHAN BATU SELATAN JL. PERINTIS NO. 18 SIMPANG KAWAT DUSUN I KELURAHAN HESSA PERLOMPONGAN KECAMATAN AIR BATU KABUPATEN ASAHAN


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NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

9

1400000000714

KLINIK KESUMA BANGSA

JL. LINTAS SUMATERA NO. 9 DUSUN I DESA RAHUNING KECAMATAN RAHUNING KABUPATEN ASAHAN

085261585 929

DRG ZANIYAR

PER/30/12/2015

RS.TRAUMA CENTRE

01/12/2016

31/12/2016

10

1400000000714

KLINIK KESUMA BANGSA

JL. LINTAS SUMATERA NO. 9 DUSUN I DESA RAHUNING KECAMATAN RAHUNING KABUPATEN ASAHAN

085261585 929

DRG ZANIYAR

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

11

1400000000727

KLINIK MITRA SEHAT

JL. KARTINI NO. 195 KECAMATAN KOTA KISARAN BARAT KABUPATEN ASAHAN

081262861 45


PER/30/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

12

1400000000718

KLINIK RAKYAT

JL. SM RAJA UJUNG BANDAR KECAMATAN RANTAU SELATAN KABUPATEN LABUHAN BATU

081262861 45


PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

13

1500000000129

MITRA KLINIK DR H AHYAR RANGKUTI

DUSUN 1C DESA KAMPUNG PAJAK KEC NA IX-X

HALIMAH SARI RANI MARPAUNG

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

14

1500000000662

PUSKESMAS INDRAPURA

JL. JENDRAL SUDIRMAN NO. 63 BATUBARA

081376616 429

PUSKESMAS INDRAPURA

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

15

1500000000663

PUSKESMAS KEDAI SIANAM

JL. H.MUHAMMAD ZEIN DESA KEDAI SIANAM KEC. LIMA PULUH KAB. BATU BARA

081361449 866

PUSKESMAS KEDAI SIANAM

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

16

1500000000665

PUSKESMAS LABUHAN RUKU

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

081362061 445

PUSKESMAS LABUHAN RUKU

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

17

1500000000675

PUSKESMAS LALANG

JL. ACCES ROAD INALUM DESA LALANG KEC. MEDANG DERAS KAB. BATU BARA

PUSKESMAS LALANG

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

18

1500000000676

PUSKESMAS LAUTADOR

KEC. LAUTADOR KAB. BATU BARA

PUSKESMAS LAUTADOR

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

19

1500000000666

PUSKESMAS LIMA PULUH

JL. PERINTIS KEMERDEKAAN NO.73 KEL. LIMA PULUH KEC. LIMA PULUH KAB. BATU BARA

PUSKESMAS LIMA PULUH

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

20

1500000000667

PUSKESMAS PAGURAWAN

JL. SUDIRMAN NO.149 KEL.P.DODEK KEC. MEDANG DERAS KAB. BATU BARA

PUSKESMAS PAGURAWAN

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I


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KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

21

1500000000668

PUSKESMAS PEMATANG PANJANG

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

081264704 44

PUSKESMAS PEMATANG PANJANG

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

22

1500000000669

PUSKESMAS PETATAL

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

085275999 784

PUSKESMAS PETATAL

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

23

1500000000670

PUSKESMAS SEI BALAI

JL.PERINTIS KEMERDEKAAN DESA SEI BALAI KEC.SEI BALAI KAB. BATU BARA

082360571 537

PUSKESMAS SEI BALAI

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

24

1500000000671

PUSKESMAS SEI SUKA

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

PUSKESMAS SEI SUKA

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

25

1500000000672

PUSKESMAS SIMPANG DOLOK

DUSUN I DESA SIMPANG DOLOK KAB. BATU BARA

081361063 456

PUSKESMAS SIMPANG DOLOK

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

26

1500000000673

PUSKESMAS TANJUNG TIRAM

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

081264222 800

PUSKESMAS TANJUNG TIRAM

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

27

1500000000674

PUSKESMAS UJUNG KUBU

JL. BESAR UJUNG KUBU DUSUN IV KAB. BATU BARA

081361006 865

PUSKESMAS UJUNG KUBU

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

28

1400000000294

RS SETIO HUSODO

JL. SISINGAMANGARAJA NO. 67 KEL. KISARAN TIMUR KEC. KOTA KISARAN TIMUR

44999

MARDI

PER/30/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

29

1500000001895

RSU AVICENNA

JL. LINTAS SUMATERA SIMPANG SIRANGGONG DAMULI PEKAN KABUPATEN LABUHANBATU UTARA

7672018

TOSIP TANJUNG

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

30

1500000001235

RSU TIGA BERSAUDARA

JL. SIMONIS DUSUN I A DESA KAMPUNG PAJAK KECAMATAN NA IX-X

081360103 239

DR M LATIF SITUMORANG

PER/30/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

31

1400000000468

RSU WIRA HUSADA

JL. KARTINI NO. 209 KEL. SENDANG SARI KEC. KOTA KISARAN BARAT

42532

DR. DIAH JULIANA NST

PER/30/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

32

1500000000541

RSUD KABUPATEN BATU BARA

JL. DATUK KWALA GUNUNG KECAMATAN LIMA PULUH KABUPATEN BATU BARA

RSUD KABUPATEN BATU BARA

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I


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KODE PROVIDER

:

B03- KANTOR CABANG PADANG SIDEMPUAN

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

AWAL IKS

AKHIR IKS

DR YUDIKA KRISTIANA ZENDRATO

PER/29/042016

RS.TRAUMA CENTRE

05/04/2016

31/12/2016

DR ELNI RUBIANTI DAULAY

PER/16/032016

RS.TRAUMA CENTRE

24/03/2016

31/12/2016

361450301

HJ NURSYAM

PER/11/022016

RS.TRAUMA CENTRE

24/03/2016

31/12/2016

JL MANGARAJA BATANG PANE NO 56 GUNUNG TUA

396746406

DR.HJ.ZUNAIDAH HASANAH M.KES

PER/17/032016

RS.TRAUMA CENTRE

24/03/2016

31/12/2016

PRAKTEK 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

1400000000583

PRAKTEK DOKTER RIKKY N HARAHAP

JL R SUPRAPTO NO 70 SIBOLGA

62646523

DR RIKKY N HARAHAP

PER/10/022016

RS.TRAUMA CENTRE

24/03/2016

31/12/2016

7

1400000000580

PRAKTEK DOKTER SRI PRIHATIN K N HARAHAP

JL LINTAS GUNUNGTUA-LANGGA PAYUNG DESA SIHOPUK BARU

DR SRI PRIHATIN K N HARAHAP

PER/08/022016

RS.TRAUMA CENTRE

26/02/2016

31/12/2016

8

1400000000578

PRAKTEK DOKTER SRI WAHYUNI

JL SULTAN HASANUDDIN NO 30 PADANG SIDIMPUAN

DR SRI WAHYUNI

PER/09/022016

RS.TRAUMA CENTRE

03/03/2016

31/12/2016

9

1500000000689

PRAKTEK DOKTER YUDIKA KRISTIANA

JL YOSSUDARSO NO 160 GUNUNGSITOLI

DR YUDIKA KRISTIANA

PER/29/042016

RS.TRAUMA CENTRE

12/04/2016

31/12/2016

10

1500000000178

PRAKTEK DR ASRIAL

JL SM RAJA NO 200 PADANGSIDIMPUAN

DR ASRIAL

PER/14/022016

RS.TRAUMA CENTRE

03/03/2016

31/12/2016

11

1400000000186

RS METTA MEDIKA

JL SUTOYO SISWOMIHARJO NO 34 SIBOLGA

25007

PT METTA MEDIKA

PER/15/032016

RS.TRAUMA CENTRE

10/03/2016

31/12/2016

12

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

1

06041

DR YUDIKA KRISTIANA

JL. YOS SUDARSO NO. 160

2

1500000000185

KLINIK DAFFA

JL SUDIRMAN LINGKUNGAN I PASAR SIBUHUAN

3

1400000000584

KLINIK HARAPAN BUNDA

JL ELANG NO 35 KELURAHAN AEK MANIS

4

1400000000585

KLINIK MEDICA

5

1500000000316

6

MA11222I

081376630 933

TIPE IKS

6455987


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

13

1500000000690

RSU PERMATA MADINA SIBUHUAN

JL KIHAJAR DEWANTARA

14

7-2830687153

RSUD PADANGSIDIMPUAN

JL F L TOBING NO 10

15

1400000000683

RSUD PANDAN

DR FERDINAND LUMBAN TOBING NO 5

16

1400000000344

RSUD SIBUHUAN

JL KI HAJAR DEWANTARA SIBUHUAN

17

1500000000260

RUMAH SAKIT TK IV 01.07.03

JL JEND SUDIRMAN NO 1 KAB TAPANULI SELATAN

KANTOR CABANG

NO

KODE PROVIDER

:

KODE POS

IKS TELEPON

PIMPINAN NO IKS

421060

22711

421678

TIPE IKS

AWAL IKS

AKHIR IKS

DR.MUSBAR

PER/19/032016

RS.TRAUMA CENTRE

24/03/2016

31/12/2016

PEMERINTAH KOTA PADANGSIDIMPUAN

PER/25/032016

RS.TRAUMA CENTRE

07/04/2016

31/12/2016

PER/26/032016

RS.TRAUMA CENTRE

24/03/2016

31/12/2016

PEMDA

PER/18/032016

RS.TRAUMA CENTRE

24/03/2016

31/12/2016

BAGINDA HARAHAP

PER/20/032016

RS.TRAUMA CENTRE

24/03/2016

31/12/2016

B04- KANTOR CABANG TANJUNG MORAWA

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000001892

BALAI PENGOBATAN HOMBING

JL. SUDIRMAN NO. 148 NO. 148 DOLOK MASIHUL

085260446 061

DR. JANNES E. SIHOMBING

PER/26/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

2

1400000000619

BPS KULON PROGO

JL. BATANG KUIS GG. KANDAR NO. 8 DS TELAGA SARI TANJUNG MORAWA

7942321

DR. ARSYAD

PER/20/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

3

1400000000033

BPS KURNIA SEHAT

JL. JEND SUDIRMAN LK.02 (DEPAN RS SRI PAMELA)

TAN ERFI

PER/14/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

4

1400000000031

BPS MORAWA

JL. MEDAN-LUBUK PAKAM KM. 17

TAN ERFI

PER/16/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

MA11222I

7942361


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

5

1400000000412

KLINIK 24 JAM DR. IRVAN DALIMUNTHE

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

6

7-1240382124

KLINIK ABIZA

DSN II DESAS SILAU RAKYAT KEC. SEI RAMPAH

7

1400000000405

KLINIK ARDIFARMA JAYA

8

1400000000037

9

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

23443444

DR. IRVAN DALIMUNTHE

PER/18/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

085359461 777

SAMSINAR

PER/29/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

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

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

1400000000404

KLINIK PRATAMA AFIYAH AMPLAS

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

80019975

DRS. H. ARENA TRI JAYA GINTING, MM

PER/19/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

10

1500000001880

KLINIK PRATAMA ESSIVA

JL. PASAR VII NO. 16 DESA TEMBUNG KEC. PERCUT SEI TUAN

7380666

DR. JHONES R. SIPAYUNG

PER/24/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

11

1500000000070

KLINIK PRATAMA KULON PROGO BANGUN SARI

JL. MEDAN-TJ.MORAWA DESA BANGUN SARI

085275246 273

DR. MUHAMMAD ARSHAD

PER/23/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

12

1400000000590

KLINIK PRATAMA MANNA

JL. PERTAHANAN NO. 98 PATUMBAK

DR. JHONI SINAGA

PER/21/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

13

1500000001879

KLINIK PRATAMA MARS

JALAN GALANG DUSUN IA NO. 121 DESA PURWODADI KEC. PAGAR MERBAU

7952511

MARHEN, AMK

PER/25/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

14

1500000000069

KLINIK PRATAMA PAKAM

JL. MEDAN NO. 38 A LUBUK PAKAM

081265238 15

DR. MUSA TOGI MARPAUNG

PER/22/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

15

7-1242107043

KLINIK PUJA

JL. BESAR PETUMBUKAN NO. 12 DS PETUMBUKAN KEC. GALANG

20585

DR. BALBIR SINGH, MD

PER/30/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

16

7-1239985383

KLINIK RAIHAN

MENTENG INDAH BLOK B1 NO. 29 MEDAN

20228

DR.DRG SUCI ERAWATI M.KES

PER/28/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

MA11222I

20995

20351

20351

081265410 449


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KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

PER/15/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

082167926 514

PER/27/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

DESA BANDAR BARU KEC. BANDAR BARU

081397941 999

PER/27/01/2016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

PUSKESMAS BANDAR DOLOK

DESA BANDAR DOLOK KEC. BANDAR DOLOK

081376670 815

PER/27/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

1400000000709

PUSKESMAS BANDAR KHALIPAH

DESA BANDAR KHALIPAH KEC. PERCUT SEI TUAN

081362408 181

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

22

1400000000682

PUSKESMAS BANGUN PURBA

DESA BANGUN PURBA KEC. BANGUN PURBA

085262706 056

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

23

1400000000707

PUSKESMAS BATANG KUIS

BATANG KUIS KEC. BATANG KUIS

081265406 00

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

24

1400000000681

PUSKESMAS BIRU-BIRU

DESA BIRU-BIRU KEC. BIRU-BIRU

081262175 005

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

25

1400000000693

PUSKESMAS DALU SEPULUH

DESA DALU X KEC. BERINGIN

081376077 435

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

26

1400000000698

PUSKESMAS DELI TUA

DESA DELI TUA KEC. PATUMBAK

081264320 15

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

27

1400000000684

PUSKESMAS GALANG

JL. BUKIT BARISAN GALANG KOTA KEC. GALANG

081265876 80

PER/27/01/2016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

28

1400000000703

PUSKESMAS GUNUNG MERIAH

DESA GUNUNG MERIAH KEC. GUNUNG MERIAH

081397999 343

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

17

1400000000032

KLINIK TUTUN SEHATI

JL. PASAR BARU KM 17 TJ.MORAWA A NO.2

7945676

18

1400000000706

PUSKESMAS ARAS KABU

DESA ARAS KABU KEC. BERINGIN

19

1400000000719

PUSKESMAS BANDAR BARU

20

1400000000721

21

MA11222I

SALMIAH ZAKARIA


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

29

1400000000711

PUSKESMAS HAMPARAN PERAK

DESA HAMPARAN PERAK KEC. HAMPARAN PERAK

082160351 011

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

30

1400000000722

PUSKESMAS KARANG ANYER

DESA KARANG ANYER KEC. KARANG ANYER

081272118 888

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

31

1400000000720

PUSKESMAS KENANGAN

DESA KENANGAN KEC. PERCUT SEI TUAN

085358348 281

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

32

1400000000723

PUSKESMAS KOTA DATAR

DESA KOTA DATAR KEC. KOTA DATAR

082164747 266

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

33

1400000000726

PUSKESMAS KUTALIMBARU

DESA KUTALIMBARU KEC. KUTALIMBARU

081361326 400

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

34

1400000000710

PUSKESMAS LABUHAN DELI

DESA LABUHAN DELI KEC. LABUHAN DELI

081269230 222

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

35

1400000000705

PUSKESMAS LUBUK PAKAM

JL. DIPONEGORO GG. WAKAF KEC. LUBUK PAKAM

085276730 440

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

36

1400000000697

PUSKESMAS MULIOREJO

DESA MULIOREJO KEC. SUNGGAL

081375333 643

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

37

1400000000699

PUSKESMAS NAMORAMBE

DESA NAMORAMBE KEC. NAMORAMBE

081264262 444

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

38

1400000000704

PUSKESMAS PAGAR JATI

DESA PAGAR JATI KEC. LUBUK PAKAM

081265884 10

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

39

1500000000029

PUSKESMAS PANCUR BATU

DESA PANCUR BATU KEC. PANCUR BATU

082168463 332

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

40

1400000000700

PUSKESMAS PANTAI LABU

DESA PANTAI LABU KEC. PANTAI LABU

081263587 546

PER/27/01/2016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

41

1400000000694

PUSKESMAS PATUMBAK

DESA PATUMBAK KEC. PATUMBAK

085275960 879

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

42

1500000000030

PUSKESMAS PEMATANG JOHAR

DESA PEMATANG JOHAR KEC.PEMATANG JOHAR

082160580 199

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

43

1500000000031

PUSKESMAS PETUMBUKAN

DESA PETUMBUKAN KEC. PETUMBUKAN

081264151 51

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

44

1400000000724

PUSKESMAS SEI MENCIRIM

DESA SEI MENCIRIM KEC. SUNGGAL

081370221 459

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

45

1400000000702

PUSKESMAS SEI SEMAYANG

JL. SEI MENCIRIM GG. PUSKESMAS KEC. SUNGGAL

081160754 20

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

46

1400000000680

PUSKESMAS SIBOLANGIT

DESA SIBOLANGIT KEC. SIBOLANGIT

081264202 97

PER/27/01/2016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

47

1400000000725

PUSKESMAS SUKARAYA

DESA SUKARAYA KEC. SUKARAYA

081265013 29

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

48

1400000000701

PUSKESMAS TALUN KENAS

DESA TALUN KENAS KEC. TALUN KENAS

081375190 502

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

49

1400000000685

PUSKESMAS TANJUNG MORAWA

KEL. TANJUNG MORAWA PEKAN KEC. TANJUNG MORAWA

081375253 099

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

50

1400000000708

PUSKESMAS TANJUNG REJO

DESA TANJUNG REJO KEC. PERCUT SEI TUAN

081264209 777

PER/27/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

51

1400000000678

PUSKESMAS TIGA JUHAR

DESA TIGA JUHAR KEC. STM HULU

081265818 732

PER/27/01/2016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

52

1400000000030

RS GRAND MEDISTRA

JL. MEDAN-LUBUK PAKAM KM.25 NO. 66

7955114

PER/03/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

MA11222I

DRS. JOHANNES S


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

7945058

PT. MORAWA UTAMA

PER/12/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

JL. BAKARAN BATU DSN MANGGIS NO. 45 DESA TUMPATAN BERINGIN

7950449

NATANIEL P. NAINGGOLAN, SH

PER/06/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

RS SRI PAMELA

JL. JEND. SUDIRMAN NO. 299

24748

PT. SRI PAMELA MEDIKA NUSANTARA

PER/11/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

1400000000038

RSU DR.GL TOBING PTPN II

JL.RAYA MEDAN-TJ.MORAWA KM 16,5

7944796

PTPN II (PERSERO)

PER/01/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

57

1400000000035

RSU HERNA

JL. BALAI KOTA NO. 2

21476

DR. DJOHAN ZEIN

PER/02/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

58

1400000000622

RSU MELATI PERBAUNGAN

JL. DELI NO. 105-115 PERBAUNGAN

7990056

DR. TONDY

PER/07/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

59

1400000000587

RSU MITRA SEHAT

JL. SEI MERAH NO. 300 DESA DAGANG KERAWANG

77607489

DR. SUSI, MKT

PER/05/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

60

1400000000620

RSU SARI MUTIARA LUBUK PAKAM

JL. MEDAN NO. 17 LUBUK PAKAM

7951339

DRS. WASHINGTON PURBA

PER/04/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

61

1500000000099

RSU SEMBIRING DELI TUA

JL. BESAR NO. 77 DELI TUA

7030802

DRS. JOHANNES S

PER/08/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

62

1500000000248

RSUD DELI SERDANG

JL. THAMRIN LUBUK PAKAM

7952068

PEMKAB DELI SERDANG

PER/09/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

63

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

53

1500000001957

RS MORAWA UTAMA

JL. MEDAN - TJ.MORAWA KM. 18,5

54

1400000000589

RS PATAR ASIH

55

1500000001981

56

KANTOR CABANG

MA11222I

:

20351

20362

B05- KANTOR CABANG MEDAN BELAWAN


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000054

BALAI PENGOBATAN DELIMA

JL.MEDAN BELAWAN KM 21.5 MEDAN

NURDELIMA SIHOMBING

PER/08/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

2

1500000000053

KLINIK AZIZI

JL.TEMPULING NO.111 A MEDAN

DR.ANITAWATI

PER/05/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

3

1500000001219

KLINIK BINA SEJAHTERA

JL.K.L YOS SUDARSO NO.68

DISIPLIN ROSALINA G

PER/09/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

4

1400000000331

KLINIK CITRA MEDIKA

JL.PLATINA RAYA NO.58 MEDAN

DR.YUDA PRAYOGI

PER/04/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

5

1500000000231

KLINIK DANDY

JALAN RUMAH POTONG HEWAN NO.15 A

SITI HAWA MANAO

PER/01/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

6

1500000000250

KLINIK HAJI KRAKATAU

JALAN KRAKATAU NO.48 A/110 MEDAN

TAKBIR SIREGAR

PER/11/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

7-1135974186

KLINIK HAJI MEDAN KRAKATAU

JL KRAKATAU NO 48 A / 110 MEDAN

TAKBIR SIREGAR

PER/11/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

8

1500000000251

KLINIK HAJI MEDAN PANCING

JALAN WILLIEM ISKANDAR /PANCING NO.100 C

TAKBIR SIREGAR

PER/10/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

9

1500000000052

KLINIK HELVETIA III

JL.KL YOS SUDARSO SP.KANTOR

TEGUH SUHARTO

PER/06/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

10

1500000000051

KLINIK HELVETIA VIII

JL.KL YOS SUDARSO KM 20,5 MEDAN

TEGUH SUHARTO,SE

PER/07/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

11

1500000000459

KLINIK MUTIARA KOTA BANGUN

JL KL YOS SUDARSO KM 10.5

20241

NURHAYATI PURBA

PER/02/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

12

7-1919381394

KLINIK PRATAMA HARAPAN SEHAT SEJAHTERA

JL MARELAN RAYA BESI PUTIH MEDAN KEL TANAH ENAM RATUS

20245

WENDY

PER/02/022016

RS.TRAUMA CENTRE

04/02/2016

31/01/2017

MA11222I

20241

66516974

20241

96333303


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

13

7-1919381394

KLINIK PRATAMA HARAPAN SEHAT SEJAHTERA

JL MARELAN RAYA BESI PUTIH MEDAN KEL TANAH ENAM RATUS

20245

WENDY

PER/02/022016

RS.TRAUMA CENTRE

05/02/2016

31/12/2016

14

7-1918653373

KLINIK PRATAMA MEDAN DELI INDONESIA

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

20241

DR JOHNY HENDRIK

PER/01/022016

RS.TRAUMA CENTRE

04/02/2016

31/01/2017

15

7-1918653373

KLINIK PRATAMA MEDAN DELI INDONESIA

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

20241

DR JOHNY HENDRIK

PER/01/022016

RS.TRAUMA CENTRE

05/02/2016

31/12/2016

16

7-3300073231

KLINIK QYTA MEDIKA

JL KAPTEN RAHMAD BUDIN LINGKUNGAN 13 KELURAHAN TERJUN

20111

CHELLIA

PER/03/052016

RS.TRAUMA CENTRE

12/05/2016

31/12/2016

17

1400000000332

KLINIK TIMUR JAYA

JL.KL.YOS SUDARSO KM 10,6 MEDAN

DR.KURNIAWAN

PER/03/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

18

1400000000336

RS MARTHA FRISKA

JALAN KL YOS SUDARSO NO.91 MEDAN

RASIN BBA,MHA

PER/14/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

19

1400000000455

RSU MITRA MEDIKA

JL KL YOS SUDARSO KM 7.5 TJ MULIA

DR. HANIFAH, M. KES

PER/15/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

20

1400000000335

RUMAH SAKIT IMELDA

JALAN BILAL NO.24 P.BRAYAN

DR.IMELDA LIANA RITONGA

PER/13/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

21

7-3299717470

RUMAH SAKIT METHODIST MEDAN

JALAN M H THAMRIN NO 105

061736900 0

DR HENDRA W DJUANG MARS

PER/04/052016

RS.TRAUMA CENTRE

12/05/2016

31/12/2016

22

1400000000334

RUMAH SAKIT PELABUHAN BELAWAN

JL.STASIUN NO.92 BELAWAN

6941927

PT.PELABUHAN INDONESIA

PER/12/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

KANTOR CABANG

MA11222I

:

20115

B06- KANTOR CABANG BINJAI


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

1

1500000000067

BPS SARANA

JL BINJAI KM 11.7 NO 57 DESA PUJIMULYO SUNGGAL

2

1500000001924

KLINIK PRATAMA SEHAT SEHATI

JL RAYA BINJAI KM 14.6 DISKII

20351

3

7-1958871584

KLINIK PRATAMA DOA IBU

JL SUDIRMAN LINGK II SETIA NO 53 PERDAMAIAN

4

7-3004856563

KLINIK PRATAMA DORARA

JL SETIA AGUNG GG MAWAR I

5

1500000000430

KLINIK PRATAMA SARI MUTIARA TANDEM

JL TANJUNG PURA NO 98 DESA TANDEM HILIR HAMPARAN PERAK

6

7-2570400503

KLINIK PRATAMA SEMPURNA

JL GATOT SUBROTO NO 335

7

1500000000068

KLINIK PRIMA MEDIKA

JL KH ZAINUL ARIFIN NO 1 A KEC STABAT

8

7-1958581253

KLINIK UTAMA MENTARI

JL T AMIR HAMZAH KEL KWALA LANGKAT

9

7-3113228247

RS AL-FUADI

JL AHMAD YANI BINJAI

10

1500000000213

RS BANGKATAN PTPN II

JL SULTAN HASANUDDIN NO 40 BINJAI

11

7-2048054644

RSU ARTHA MEDICA BINJAI

JL SAMANHUDI NO 22 BINJAI

12

7-2030604103

RSU BIDADARI

JL. PERINTIS KEMERDEKAAN NO 147 BINJAI

MA11222I

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

PER/01/012016

RS.TRAUMA CENTRE

27/01/2016

31/12/2016

DR ELVII SUSANTI SITEPU

PER/23/042016

RS.TRAUMA CENTRE

10/05/2016

31/12/2016

20811

H BUDIANTO WAHYU WARDOYO

PER/03/022016

RS.TRAUMA CENTRE

10/02/2016

31/12/2016

20351

SUHAINI

PER/19/042016

RS.TRAUMA CENTRE

25/04/2016

31/12/2016

DR TUAHMAN

PER/12/022016

RS.TRAUMA CENTRE

29/04/2016

31/12/2016

ESRA SEMBIRING

PER/06/022016

RS.TRAUMA CENTRE

24/03/2016

31/12/2016

MANGIHUT MARATUA

PER/17/032016

RS.TRAUMA CENTRE

04/06/2016

31/12/2016

20761

EMA PURNAMA

PER/02/022016

RS.TRAUMA CENTRE

10/02/2016

31/12/2016

20711

DR H T MURAD ALFUAD

PER/22/0416

RS.TRAUMA CENTRE

28/04/2016

31/12/2016

PTPN II

PER/09/022016

RS.TRAUMA CENTRE

17/02/2016

31/12/2016

20711

ARUSTA TARIGAN

PER/08/022016

RS.TRAUMA CENTRE

17/02/2016

31/12/2016

20744

FIRMANSYAH SE MARS

PER05/022016

RS.TRAUMA CENTRE

16/02/2016

31/12/2016

370139966

396880292

20719

75080063


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NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

13

7-2030604103

RSU BIDADARI

JL. PERINTIS KEMERDEKAAN NO 147 BINJAI

20744

FIRMANSYAH SE MARS

PER/05/022016

RS.TRAUMA CENTRE

16/02/2016

31/07/2017

14

7-2502663572

RSU DELIA

JL KH DEWANTARA DUSUN I SEI LIMBAT

20762

NGOGESA SITPU

PER/16/032016

RS.TRAUMA CENTRE

15/03/2016

31/12/2016

15

1500000000429

RSU KELIAT

JL SULTAN ARAB NO 111 DESA KLUMPANG KAMPUNG HAMPARAN PERAK

PRATEN NATALIA BR KELIAT

PER/10/022016

RS.TRAUMA CENTRE

04/05/2016

31/12/2016

16

1500000000429

RSU KELIAT

JL SULTAN ARAB NO 111 DESA KLUMPANG KAMPUNG HAMPARAN PERAK

PRATEN NATALIA BR KELIAT

PER/10/022016

RS.TRAUMA CENTRE

29/04/2016

31/01/2017

17

7-2047722993

RSU LATERSIA

JL SOEKARNO HATTA NO 451

20731

ROBINSON SEMBIRING

PER/07/022016

RS.TRAUMA CENTRE

17/02/2016

31/12/2016

18

7-3113910618

RSU RATU MAS

JL T AMIR HAMZAH NO 281 A

20744

PT ROYA L MEDIKA RAYA

PER/20/0416

RS.TRAUMA CENTRE

28/04/2016

31/12/2016

19

7-2446378422

RSUD TANJUNG PURA

JL KHAIRIL ANWAR TANJUNG PURA

20853

PEMERINTAH

PER/15/032016

RS.TRAUMA CENTRE

10/03/2016

31/12/2016

KANTOR CABANG

NO

1

:

KODE PROVIDER

NAMA PROVIDER

7-3063241293

KANTOR CABANG

MA11222I

B23- KABUPATEN NIAS

KLINIK PRATAMA SEHAT

:

ALAMAT

JL LAGUNDRI NO 57 GUNUNGSITOLI

KODE POS

22811

IKS TELEPON

PIMPINAN NO IKS MANY

PER/28/042016


AWAL IKS 25/04/2016


C00- KANTOR CABANG PADANG


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ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1400000000040

KLINIK ARUM SARI

JL SUTAN SYAHRIL NO.332

081363474 133

DR FERI MULYANI

PER/44/122015

RS.TRAUMA CENTRE

01/02/2016

31/12/2016

2

1500000000954

KLINIK INTRO MEDIKA

JL H AGUS SALIM NO 19

811150

NURMIDALMI, SE

PER/20/042016

RS.TRAUMA CENTRE

04/05/2016

31/12/2017

3

7-3171683333

KLINIK PT. KSI

JORONG SUNGAI TANGAH KENAGARIAN SUNGAI KUNYIT

PT. KSI

PER/23/052016

RS.TRAUMA CENTRE

04/05/2016

31/12/2017

4

1500000000813

KLINIK SAMUDRA MEDIKA

JL PALEMBANG NO 20 GAUNG

ANI GUSMELA DEWISKA S, SIT

PER/07/022016

RS.TRAUMA CENTRE

04/05/2016

31/12/2016

5

7-2810976383

KLINIK TIN ISKANDAR MEDIKAL

JL M YAMIN SH NO 21 KAMPUNG BARU

H ISKANDAR AS

PER/14/032016

RS.TRAUMA CENTRE

05/04/2016

31/12/2016

6

1500000000635

RS BHAYANGKARA PADANG

JL JATI NO 1 PADANG

POLDA SUMBAR

PER/05/022016

RS.TRAUMA CENTRE

01/04/2016

31/12/2016

7

1500000000767

RS KHUSUS BEDAH KARTIKA DOCTA

JL. GAJAH MADA NO. 14 GUNUNG PANGILUN

H. MUSTAFA KAMAL

PER/06/022015

RS.TRAUMA CENTRE

01/04/2016

31/12/2016

8

1500000001054

RS SELAGURI

JL JEND A. YANI NO 26

DR HJ HAFLEZIANI M.KES

PER/22/042016

RS.TRAUMA CENTRE

01/05/2016

31/12/2017

9

1400000000039

RS TENTARA REKSODIWIRYO

JL DR WAHIDIN NO.1 PADANG

DATASEMEN KESEHATAN

PER/45/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

10

7-2995836423

RSJ PROF HB SAANIN PADANG

JL. RAYA ULU GADUT KEL LIMAU MANIS SELATAN

PEMPROV SUMBAR

PER/19/042016

RS.TRAUMA CENTRE

21/04/2016

31/12/2016

11

1500000000955

RSUD DR M ZEIN PAINAN

JL DR A RIVAI KOTA PAINAN

PEMDA PESISIR SELATAN

PER/21/042016

RS.TRAUMA CENTRE

04/05/2016

31/12/2017

12

7-2895404723

RSUD MENTAWAI

JL. RAYA TUAPEJAT KM 9 KEC SIPORA UTARA

PEMDA KAB KEP MENTAWAI

PER/16/042016

RS.TRAUMA CENTRE

18/04/2016

31/12/2016

MA11222I

27777

25511

67191675

4481278

31003

25161 214282151 8 25392


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ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

13

1500000000914

RSUD PARIAMAN

JL PROF M YAMIN SH NO 5

9111891428

PEMPROV SUMBAR

PER/18/042016

RS.TRAUMA CENTRE

01/05/2016

31/12/2016

14

1500000000507

RUMAH SAKIT KHUSUS BEDAH ROPANASURI

JL. AUR NO. 8 PADANG

31938

DR. QUINTA SARI, SP. KK

PER/03/022016

RS.TRAUMA CENTRE

01/04/2016

31/12/2016

15

1500000000507

RUMAH SAKIT KHUSUS BEDAH ROPANASURI

JL. AUR NO. 8 PADANG

31938

DR. QUINTA SARI, SP. KK

PER/03/012016

RS.TRAUMA CENTRE

01/04/2016

31/12/2016

16

1500000000534

RUMAH SAKIT UMUM BHAKTI KESEHATAN MASYARAKAT (BKM)

JLN JENDRAL SUDIRMAN SAGO KENAGARIAN SAGO-SALIDO KEC IV JURAI

63385109

MAWARDI

PER/04/022016

RS.TRAUMA CENTRE

01/04/2016

31/12/2016

KANTOR CABANG

NO

KODE PROVIDER

:

C01- KANTOR CABANG BUKIT TINGGI

NAMA PROVIDER

ALAMAT

1

1400000000280

PRAKTEK DR SYAHRIL S

JORONG SUDIRMAN, NAGARI MUARO KIAWAI, KEC. GUNUNG TULEH, PASAMAN BARAT

2

1400000000223

RSI IBNU SINA PAYAKUMBUH

JL PEMUDA NO 14 PAYAKUMBUH

3

1400000000239

RSI IBNU SINA SIMPANG AMPEK

4

1400000000239

5

1400000000063

MA11222I

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

DR SYAHRIL S

PER/015/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

92222

YARSI SUMATERA BARAT

PER/013/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

JL M. NATSIR PASAMAN BARU SIMPANG EMPAT PASAMAN BARAT

7464015

YAYASAN RUMAH SAKIT ISLAM SUMATERA BARAT

PER/014/072014

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

RSI IBNU SINA SIMPANG AMPEK

JL M. NATSIR PASAMAN BARU SIMPANG EMPAT PASAMAN BARAT

7464015

YAYASAN RUMAH SAKIT ISLAM SUMATERA BARAT

PER/016/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

RSUD 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


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KODE PROVIDER

:

C02- KANTOR CABANG SOLOK

NAMA PROVIDER

ALAMAT

1

1500000000548

BALAI LATIHAN KERJA KABUPATEN SOLOK

JL RAYA LUBUK SELASIH KM 01 KAYU ARO

2

1400000000099

BLUD-RSUD SAWAHLUNTO

JL KARTINI NO 18

3

1500000000749

KLINIK ALTHAF

JL M YAMIN NO 83

4

1500000000722

KLINIK ARBA

5

1500000000761

6

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

PER/18/122015

RS.TRAUMA CENTRE

05/01/2016

31/12/2016

PER/07/122015

RS.TRAUMA CENTRE

21/01/2016

31/12/2016

DR.DINI ASTA DIANI

PER/14/122015

RS.TRAUMA CENTRE

21/01/2016

31/12/2016

NAGARI SUNGAI RUMBAI TIMUR KEC SUNGAI RUMBAI

YUSNIMAR SST

PER/12/122015

RS.TRAUMA CENTRE

05/01/2016

31/12/2016

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

1500000000948

KLINIK PRATAMA NURJINIS

JL BUKIT BERBUNGA NAGARI SUNGAI RUMBAI TIMUR

NURJINIS

PER/13/122015

RS.TRAUMA CENTRE

05/01/2016

31/12/2016

7

1500000000895

PUSKESMAS ALAHAN PANJANG

KEC LEMBAH GUMANTI KABUPATEN SOLOK

PER/16/122015

RS.TRAUMA CENTRE

05/01/2016

31/12/2016

8

1500000000547

RSUD AROSUKA KABUPATEN SOLOK

JL LINTAS SUMATERA AROSUKA KABUPATEN SOLOK

PER/10/122015

RS.TRAUMA CENTRE

21/01/2016

31/12/2016

9

1500000000464

RSUD SIJUNJUNG

JL LINTAS SUMATRA KM 110 TANAH BADANTUANG

20056

PER/08/122015

RS.TRAUMA CENTRE

21/01/2016

31/12/2016

10

1400000000017

RSUD SOLOK

SIMPANG RUMBIO KOTA SOLOK

20826

PER/09/122015

RS.TRAUMA CENTRE

21/01/2016

31/12/2016

11

1500000000466

RSUD SUNGAI DAREH

JL LINTAS SUMATERA KM 2 PULAU PUNJUNG

40347

PER/11/122015

RS.TRAUMA CENTRE

05/01/2016

31/12/2016

MA11222I

ZULFAKHRI,S.SOS

74066837

DR.I.NYOMAN ARDANA PUTRA

RSUD SOLOK


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NO

KODE PROVIDER

:

D00- KANTOR CABANG PEKANBARU KOTA

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

PT. PUTERI AULIA DITA MEDICA

PER/09/042016

RS.TRAUMA CENTRE

18/04/2016

31/12/2016

DR. SITI ANDAN DEWI

PER/06/022016

RS.TRAUMA CENTRE

26/02/2016

31/12/2016

68401901

DR. YANTI FATMI, DK

PER/35/072015

RS.TRAUMA CENTRE

30/03/2016

31/12/2016

72026643

DR. IMAN RANDAL TARIGAN, SP.PD

PER/41/102015

RS.TRAUMA CENTRE

30/03/2016

31/12/2016

28411

76892989

FEBRIAN CHASRA,SE.S.FILL

PER/37/072015

RS.TRAUMA CENTRE

30/03/2016

31/12/2016

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

KLINIK PRATAMA CENDANA HUSADA

JL. JATI NO. 76 SENAPELAN

28151

HJ. ELLIYANNORA

PER/46/112015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

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

9

1200000000002

RS AWAL BROS

JL JENDRAL SUDIRMAN NO 117

47333

PT AWAL BROS PUTRA

82/IKS/0612

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

10

1500000000241

RSUD SIAK SRI INDRAPURA

JL SEI KECIL KABUPATEN SIAK

20012

HJ.ULFAH HANUM

PER/08/032015

RS.TRAUMA CENTRE

28/02/2016

31/12/2016

11

7-300282953

RUMAH SAKIT ISLAM IBNU SINA

JL. MELATI NO. 60

0761 24242

PT. SYIFA UTAMA

PER/45/112015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

12

1500000001341

RUMAH SAKIT PEKANBARU MEDICAL CENTER

JALAN LEMBAGA PEMASYARAKATAN NO. 25 GOBAH, PEKANBARU

848100

PT. PEKANBARU MEDIKAL SENTER

PER/27/062015

RS.TRAUMA CENTRE

30/03/2016

31/12/2016

1

7-2918533335

AULIA HOSPITAL

JL. HR SUBRANTAS NO. 63

28293

2

7-2146926741

KLINIK DR. ANDAN DEWI

JL. LINTAS TIMUR KM 34

28383

3

1500000001877

KLINIK FELLITA

JL. KAHARUDDIN NASUTION NO. 145-146 MAHARATU MARPOYAN DAMAI

28111

4

1500000001988

KLINIK FIDYA

JL. LINTAS TIMUR - PASAR SOREK SATU

5

1500000001878

KLINIK PELITA HATI

JALAN RAYA TALUK KUANTAN DESA LUBUK SAKAT PERHENTIAN RAJA

6

1500000001770

KLINIK PRATAMA BMC PEKANBARU

7

7-492772759

8

MA11222I

28122

6700.000


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13

KODE PROVIDER

RUMAH SAKIT TENTARA PEKANBARU

1500000000141

KANTOR CABANG

NO

NAMA PROVIDER

KODE PROVIDER

:

ALAMAT

KODE POS

JL KESEHATAN NO 1 PEKANBARU

IKS TELEPON

PIMPINAN NO IKS

22426

DR.YUDHI DORANDES

PER/02/022015

TIPE IKS

AWAL IKS

RS.TRAUMA CENTRE

01/01/2016


D01- KANTOR CABANG TANJUNG PINANG

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1400000000014

BALAI PENGOBATAN TIARA MEDIKA

JL. TELUK SASAH TANJUNG UBAN

484427

DR ERIKA M KAMIL

PER/57/022016

RS.TRAUMA CENTRE

04/03/2016

31/12/2016

2

1500000000461

KLINIK ANANDA

JALAN D.I PANJAITAN KM 10

081270276 85

KLINIK ANANDA

PER/59/122015

RS.TRAUMA CENTRE

26/03/2016

31/12/2016

3

1500000001213

KLINIK AZZAHRA

JL. HANG JEBAT KIJANG

KLINIK AZZAHRA

PER/66/2015

RS.TRAUMA CENTRE

27/04/2016

31/12/2016

4

1500000000924

KLINIK ERNES

JL.PERMAISURI NO.08 TANJUNG UBAN KEPULAUAN RIAU

DR.ODRI ANGNES T

PER/67/122015

RS.TRAUMA CENTRE

01/05/2016

31/12/2016

5

1500000001281

KLINIK ERNES PT. ALAM INDAH BINTAN

JL. LOT 1-2-3 LAGOI

DR. ODRI ANGNES T

PER/07/012016

RS.TRAUMA CENTRE

11/06/2016

31/12/2016

6

05338

PPK-I RSUP KEPULAUAN RIAU - TG UBAN

JL INDUN SURI , TANJUNG UBAN

482655

PEMERINTAH PROPINSI KEPRI

PER/64/122015

RS.TRAUMA CENTRE

04/03/2016

31/12/2016

7

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

8

1500000000321

PUSKESMAS KAMPUNG BUGIS

JALAN ABDUL RAHIM KELURAHAN KAMPUNG BUGIS, TANJUNGPINANG


PER/62/122015

RS.TRAUMA CENTRE

09/03/2016

31/12/2016

MA11222I

085265696 020


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

9

1500000000923

PUSKESMAS MEKAR BARU

JL CENDERAWASIH KM 8 TANJUNGPINANG

10

1500000000638

PUSKESMAS MELAYU KOTA PIRING

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

11

00311

RSAL DR MIDIYANTO

JL CIPTADI 1

12

1400000000093

RSUD KABUPATEN BINTAN

JL. BAREK MOTOR NO 2B KIJANG

13

1400000000061

RSUD KERPI TANJUNG UBAN

14

1500000000462

RSUD KOTA TANJUNGPINANG

JL SUDIRMAN 795

15

1400000000013

RSUP KEPRI TANJUNGPINANG KM 8

JL. BARU SUNGAI CARANG KM.8 TANJUNGPINANG

16

7-2375079192

RUMAH SAKIT ANGKATAN LAUT DR MIDIYATO S TANJUNG PINANG

JALAN CIPTADI NO I TANJUNGPINANG

KANTOR CABANG

NO

1

KODE PROVIDER

1400000000048

MA11222I

:

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

RIAMA SARAGI

PER/68/122015

RS.TRAUMA CENTRE

01/05/2016

31/12/2016

PUSKESMAS MELAYU KOTA PIRING

PER/69/122015

RS.TRAUMA CENTRE

27/04/2016

31/12/2016

PER/14/032016

RS.TRAUMA CENTRE

04/03/2016

31/12/2016

RSUD KABUPATEN BINTAN

PER/71/122015

RS.TRAUMA CENTRE

29/04/2016

31/12/2016

482795

PEMERINTAH PROPINSI KEPRI

PER/64/122015

RS.TRAUMA CENTRE

04/03/2016

31/12/2016

313000

RSUD KOTA TANJUNGPINANG

PER/18/032015

RS.TRAUMA CENTRE

30/03/2016

31/12/2016

PEMERINTAH PROVINSI KEPULAUAN RIAU

PER/58/122015

RS.TRAUMA CENTRE

07/03/2016

31/12/2016

DR. AHMAD SAMSULHADI

PER/14/032016

RS.TRAUMA CENTRE

04/03/2016

31/12/2016

7003559

21428

29111

D02- KANTOR CABANG BATAM NAGOYA

NAMA PROVIDER

BATAMINDO INDUSTRIAL PARK KLINIK

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

KODE POS

29433

IKS TELEPON

PIMPINAN NO IKS

611907

BATAMINDO INDUSTRIAL PARK KLINIK

PER/59/122015



AWAL IKS 01/01/2016


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

2

1400000000382

BP BATAM VIEW BEACH RESORT

KOMPLEK BATAM VIEW BEACH RESORT JL.HANG LEKIR NONGSA

29466

3

1400000000026

BP BUDI ROSARI

JALAN MAHKOTA SIMPANG NO.1 BENGKONG MAHKOTA BATAM

29458

4

1400000000595

BP HARAPAN KITA BATU AJI

RUKO CENTRAL MUKA KUNING BLOK A NO.8 BATU AJI

29438

5

1400000000025

BP HARAPAN KITA PURI LEGENDA

RUKO PURI LEGENDA BLOK D3 NO.17 BATAM

6

1500000000587

BP HARAPAN KITA SUKAJADI

7

1500000000348

8

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

DR MELATI

PER/62/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

BC GULIMAN MANURUNG

PER/58/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

077836147 5

PT AUDY JAYA PRATAMA

PER/47/122015

RS.TRAUMA CENTRE

04/01/2016

31/12/2015

29464

8096104

YULIANA AMD.KEB SE

PER/50/12015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

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

KLINIK ALAM SEHAT KABIL

KOMP RUKO TAMAN JASINTA INDAH BLOK A NO 15-16 KEL KABIL KEC NONGSA BATAM

29467

711569

EMMI KRISTIANI SIREGAR

PER/64/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

1400000000644

KLINIK BATAMEDIKA

KOMPLEK SAMPURNA CENTER BLOK F NO 07 KEL DURIANGKANG KEC SEI BEDUK TANJUNG PIAYU

29437

64212392

DR KRISMADIES M.KKK

PER/48/122015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

9

1500000000822

KLINIK HUSADATAMA

JL.IMAM BONJOL KOMP.GALAXY NO.3-4 NAGOYA BATAM

29444

431457

DR.KRISMADIES, M.KKK

PER/57/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

10

1400000000072

KLINIK MEDIKA

JL R.E MARTADINATA, KOMP WIJAYA BLOK G NO.5 SEKUPANG. BATAM

29425

082389094 888

DR KRISMADIES, M.KKK

PER/53/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

11

1400000000466

KLINIK NAYAKA HUSADA 03 KABIL

RUSUNAWA BPJS KETENAGAKERJAAN KABIL

29467

711448

PT NAYAKA ERA HUSADA

PER/64/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

12

1400000000074

KLINIK NAYAKA HUSADA 04 NAGOYA

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

13

1400000000071

KLINIK PANBIL MEDIKA

KOMP. PERDAGANGAN PANBIL BLOK A NO.9 MUKA KUNING BATAM

29433

371338


PER/52/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I

761740


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

14

1500000000821

KLINIK PRIMA HUSADA

KOMPLEK RUKO SMK ALJABAR BLOK B NO.3 BENGKONG INDAH BATAM

29458

61433634

DR.KRISMADIES,M.KKK

PER/56/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

15

1500000000819

KLINIK PURI SEHAT

RUKO PURI LEGENDA BLOK D3 NO.9 BATAM CENTER

29464

38701249


PER/54/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

16

1400000000297

KLINIK TAMARA

JL ENGKU PUTRI RUKO TAMAN LAKOTA BLOK F NO 8-9 BATAM CENTER

29464

8097629

DR ANJARI WAHYU WARDHANI

PER/61/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

17

1500000000820

KLINIK XYSTERA

KOMPLEK GENTA PLAZA BLOK B NO. 5-6 MUKA KUNING BATAM

29439

7293995


PER/55/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

18

0900000000028

RS AWAL BROS

JL GAJAH MADA KAV I BALOI

431777

DR WIDYA PUTRI

PER/01/012016

RS.TRAUMA CENTRE

11/01/2016

31/03/2016

19

0700000000015

RS CAMATHA SAHIDYA

JL A YANI NO. 8 MUKA KUNING

29433

371003

PT CAMATHA SAHIDYA

PER/65/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

20

1300000000017

RS HARAPAN BUNDA

JL SERAYA 01. BATAM

29452

457333

YAYASAN HARAPAN BUNDA

PER/66/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

KANTOR CABANG

NO

KODE PROVIDER

:

D03- KANTOR CABANG DUMAI

NAMA PROVIDER

ALAMAT

1

1400000000208

BALAI PENGOBATAN MUTIARA KASIH

JL RAYA LUBUK GAUNG RT 008 SEI SEMBILAN

2

1500000000239

BP AMANAH

JL SOEKARNO HATTA KM 14 BAGAN BESAR

MA11222I

KODE POS

28882

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

IR BURJU SIHOMBING

PER / 21 / 062015

RS.TRAUMA CENTRE

18/04/2016

31/05/2016

DR. DEVY DIANNY

PER/45/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

3

1400000000024

KLINIK RAWAT INAP TUNAS MUDA MEDIKA

JL WAN DAHLAN IBRAHIM NO 8 DUMAI

28811

439026

DR RAHMI SALBI

PER/47/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

4

1500000000623

KLINIK AL UMMI

JL BELIMBING NO.123 KEL RIMBA SEKAMPUNG KEC. DUMAI KOTA

28811

34351

ANDI RONI

PER/43/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

5

1500000000622

KLINIK AL UMMI SUNGAI SEMBILAN

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

28813

34351

ANDI RONI

PER/44/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

6

1400000000518

KLINIK ROHIL MEDIKA

JL LINTAS BAGANSIAPIAPI LENGGADAI HILIR KEC RIMBA MELINTANG

28953

MUHAMMAD SYUKRI

PER/48/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

1500000000238

KLINIK SEHATI

JL. PANGERAN DIPONEGORO/SUKAJADI NOMOR 83B

28811

34584

DR. H. SUNARYO

PER/46/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

8

1500000000424

PKM BUKIT KAPUR

JL. SOEKARNO HATTA KM 17 KEL BAGAN BESAR

78050705

DINAS KESEHATAN KOTA DUMAI

PER/10/03/2016

RS.TRAUMA CENTRE

04/04/2016

31/03/2017

9

1500000000426

PKM BUKIT KAYU KAPUR

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

78799339


PER/12/032016

RS.TRAUMA CENTRE

04/04/2016

31/03/2017

10

1500000000432

PKM BUKIT TIMAH

KOMP. BTN BUMI DUMAI BARU KEL BUKIT TIMAH

71304595


PER/08/03/2016

RS.TRAUMA CENTRE

04/04/2016

31/03/2017

11

1500000000423

PKM BUMI AYU

JL. BUDI UTOMO KEL BUMI AYU

18177095


PER/07/032016

RS.TRAUMA CENTRE

04/04/2016

31/03/2017

12

1500000000422

PKM DUMAI BARAT

JL. MH THAMRIN KEL PANGKALAN SESAI

07593322


PER/05/032016

RS.TRAUMA CENTRE

04/04/2016

31/03/2017

13

1500000000419

PKM DUMAI KOTA

JL. PATTIMURA KEL.DUMAI KOTA KEC. DUMAI KOTA

76879661


PER/03/032016

RS.TRAUMA CENTRE

04/04/2016

31/03/2017

14

1500000000421

PKM JAYAMUKTI

JL. KH NASUTION KEL. JAYA MUKTI

83771888


PER/04/032016

RS.TRAUMA CENTRE

04/04/2016

31/03/2017

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

15

1500000000425

PKM MEDANG KAMPAI

JL. RAYA DUMAI SEI PAKNING KM 11 KEL. TELUK MAKMUR

28065693


PER/11/03/2016

RS.TRAUMA CENTRE

04/04/2016

31/03/2017

16

1500000000420

PKM PURNAMA

JL. TUN SRI LANANG NO.3A KEL. PURNAMA

66780687


PER/06/032016

RS.TRAUMA CENTRE

04/04/2016

31/03/2017

17

1500000000433

PKM SUNGAI SEMBILAN

JL. RAYA DUMAI BASILAM BARU KM 14 KEL. LUBUK GAUNG

78038833


PER/09/032016

RS.TRAUMA CENTRE

04/04/2016

31/03/2017

18

1400000000492

RS CAHAYA

JL LINTAS RIAU UJUNG TANJUNG

66818300

DRG CAHAYA PURNAMA SARI

PER/49/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

19

1300000000020

RSUD DUMAI

JL TANJUNG JATI NO 4

38367

PEMKO DUMAI

PER/50/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

KANTOR CABANG

NO

1

KODE PROVIDER

1

KODE PROVIDER

1400000000092

MA11222I

D04- KANTOR CABANG RENGAT

NAMA PROVIDER

7-2792259267

KANTOR CABANG

NO

:

KLINIK PRATAMA THIP

:

28983

ALAMAT

REGIONAL OFFICE PULAI

KODE POS

IKS TELEPON

PIMPINAN NO IKS

29255

PT THIP PLANTATIONS

PER/01/042016

TIPE IKS

AWAL IKS

RS.TRAUMA CENTRE

05/04/2016


D05- KANTOR CABANG DURI

NAMA PROVIDER

BALAI PENGOBATAN DIAN HUSADA

ALAMAT

JL. GAJAH MADA NO. 31 SEBANGA DURI

KODE POS

IKS TELEPON

PIMPINAN NO IKS

92404

HARIANSYAH

PER/06/042015



AWAL IKS 01/04/2016


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

2

1400000000086

BALAI PENGOBATAN DURI MEDIKA

JL. JEND SUDIRMAN RT/RW 02/05 KEL. BALAI MAKAM DURI

594469

NENNI TRIANA

PER/07/042015

RS.TRAUMA CENTRE

01/04/2016

31/12/2016

3

1500000000412

KLINIK NAYAKA HUSADA DURI

JL DEWI SARTIKA KELURAHAN BALIK ALAM KECAMATAN MANDAU

598085


PER/02/032015

RS.TRAUMA CENTRE

01/04/2016

31/12/2016

4

1500000000413

KLINIK NAYAKA HUSADA II

JALAN HANGTUAH RT 04 RW 01 DESA TAMBUSAI BATANG DUI KECAMATAN MANDAU

560757


PER/03/032015

RS.TRAUMA CENTRE

01/04/2016

31/12/2016

5

7-3273749957

KLINIK PRATAMA ADELIA MEDICAL

JL LINTAS PEKANBARU DURI PANGKALAN LIBUT PINGGIR

28784

TAUFIK

7-3273749957

RS.TRAUMA CENTRE

01/06/2016

31/12/2016

6

7-1704752493

KLINIK PRATAMA BERKAH

JALAN LINTAS DURI – PEKANBARU DESA PINGGIR

28784

AFRIZAL TANJUNG

7-1704752493

RS.TRAUMA CENTRE

17/02/2016

31/12/2016

7

7-1704752493

KLINIK PRATAMA BERKAH

JALAN LINTAS DURI – PEKANBARU DESA PINGGIR

28784

AFRIZAL TANJUNG

7-1704752493

RS.TRAUMA CENTRE

02/02/2016

31/12/2016

8

1500000000411

KLINIK PRATAMA HAYATI

JL DURI-DUMAI KM 16 DESA BONCAH MAHANG KECAMATAN MANDAU

71049091

RUSYDI

PER/01/032015

RS.TRAUMA CENTRE

24/03/2016

31/12/2016

9

1500000000593

RSUD KECAMATAN MANDAU

JL. STADION NO. 10 DURI

7038918

RSUD KECAMATAN MANDAU

PER/04/042015

RS.TRAUMA CENTRE

01/04/2016

31/12/2016

10

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

MA11222I

:

D06- KANTOR CABANG PEKANBARU PANAM


SM0480



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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

1

7-2621518864

KLINIK FAMELA JAYA MEDIKA

JL KUBANG RAYA KEC. SIAK HULU KAMPAR

2

1500000000766

KLINIK KELUARGA SEHAT DOKTOR BASTIAN

JL GARUDA SAKTI KM 2

3

7-2671295923

KLINIK PRATAMA DAREL MEDIKA

JL. SUKARNO HATTA NO 8C PEKANBARU

4

7-2671295925

KLINIK PRATAMA DOKTER HARRY BARMA

JL RAYA PEKANBARU-BANGKINANG KM 39

5

1500000000538

KLINIK PRATAMA UWA MEDIKA

JL HR SUBRANTAS NO 92 A-C KEL SIMPANG BARU

6

1500000000646

RS SURYA INSANI

7

1400000000027

RUMAH SAKIT SANSANI

KANTOR CABANG

NO

KODE PROVIDER

:

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

MERI MURNIATI

PER/04/032016

RS.TRAUMA CENTRE

24/03/2016

20/03/2017

DR ADOLF BASTIAN TAMBUSAI.M.PD

PER/09/052016

RS.TRAUMA CENTRE

11/05/2016

10/05/2017

28282

DEFRI

PER/03/032016

RS.TRAUMA CENTRE

24/03/2016

20/03/2017

28461

DR HARRY BARMA

PER/05/032016

RS.TRAUMA CENTRE

24/03/2016

20/03/2017

7872833

DR DEFRI

PER/02/032016

RS.TRAUMA CENTRE

15/04/2016

14/04/2017

JL. DIPONEGORO KM 4 PASIR PENGARAIAN

7003404

PT.SURYA INSANI

PER/06/042016

RS.TRAUMA CENTRE

22/04/2016

21/04/2017

JALAN SOEKARNO HATTA (ARENGKA ATAS) PEKANBARU

564666

SYAHRONI TUA

PER/01/032016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

28471

7875077

D07- KANTOR CABANG BATAM SEKUPANG

NAMA PROVIDER

ALAMAT

1

1400000000574

KLINIK DUNIA MEDICAL CENTRE

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

2

7-1265428985

KLINIK GLOBAL MEDICAL CENTRE

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

MA11222I

KODE POS

KODE POS

29428

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

3581242

DR KON SAN

PER/04/022016

RS.TRAUMA CENTRE

26/02/2016

31/01/2017

077835829 23

RIRIS LIANI

PER/02/012016

RS.TRAUMA CENTRE

05/01/2016

03/01/2017


SM0480



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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

3

1400000000255

KLINIK VELY

KOMPLEK RUKO FANINDO BLOK A NO 12 A KEL TANJUNG UNCANG

4

1400000000132

KLINIK YAHYA MEDICAL CENTER

RUKO SAGULUNG PERMAI BLOK B NO 14-15 BATU AJI

KANTOR CABANG

NO

:

KODE PROVIDER

KODE POS

29422

IKS TELEPON

NO IKS PER/01/01/2016

RS.TRAUMA CENTRE

05/01/2016

03/02/2017

392748

SYARIEF A. FAHMI, ST

PER/03/012016

RS.TRAUMA CENTRE

05/01/2016

03/01/2017

ALAMAT

KODE POS

IKS TELEPON

JL RADEN MATTAHER NO 03

23246

2

0700000000017

RS DR BRATANATA

JL RD MATTAHER NO 33

20388

3

1400000000560

RS ROYAL PRIMA JAMBI

JL RADEN WIJAYA RT 35 KEBON KOPI

4

1400000000028

RSUD H ABDUL MANAP

JL SK RD SYAHBUDDIN MAYANG MANGURAI

1

7-2348650113

MA11222I

PIMPINAN NO IKS

RS BHAYANGKARA JAMBI

KODE PROVIDER

AKHIR IKS

DR. SITI VERA NOTARINA

1400000000559

NO

AWAL IKS

E00- KANTOR CABANG JAMBI

NAMA PROVIDER

:

TIPE IKS

9131737

1

KANTOR CABANG

PIMPINAN

RS DR BRATANATA

670455

TIPE IKS

AWAL IKS

AKHIR IKS

PER / 03 / 012016

RS.TRAUMA CENTRE

20/01/2016

30/11/2016

PER / 02 / 012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

PER / 01 / 012016

RS.TRAUMA CENTRE

20/01/2016

30/11/2016

PER / 06 / 012016

RS.TRAUMA CENTRE

29/04/2016

31/12/2016

E01- KANTOR CABANG MUARO BUNGO

NAMA PROVIDER

KLINIK RATU DUTA

ALAMAT

JL LINTAS SUMATERA KM 01 KEL PASAR SAROLANGUN

KODE POS

37481

IKS TELEPON

PIMPINAN NO IKS INDRA GUNAWAN SE

PER/01/032016



AWAL IKS 22/03/2016


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

2

1400000000052

KLINIK SEHAT KELUARGA CERIA

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

3

1500000000297

RSU MAYJEN H.A THALIB (TC)

JL JEND BASUKI RAHMAT NO 1 SUNGAI PENUH - PROP JAMBI

4

1400000000053

RSUD CHATIB QUZWAIN SAROLANGUN

JL. LINTAS SUMATERA KM.09 DESA BUKIT,SAROLANGUN

KANTOR CABANG

NO

:

KODE PROVIDER

KODE POS

IKS TELEPON

PIMPINAN NO IKS

21447

TIPE IKS

AWAL IKS

AKHIR IKS

M EFFENDI HARAHAP

PER/ 03/ 032016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

PEMDA KERINCI

PER/08/102015

RS.TRAUMA CENTRE

27/01/2016

30/09/2016

DR IRWAN MISWAR

PER/01/032016

RS.TRAUMA CENTRE

11/05/2016

28/02/2017

G00- KANTOR CABANG PALEMBANG

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000183

RS MUHAMMADIYAH PALEMBANG

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

513144

DR. H. YUDI FADILAH, SPPD, FINASIM

PER/03/012015

RS.TRAUMA CENTRE

14/01/2016

31/12/2016

2

1400000000163

RS PELABUHAN PALEMBANG

JL MAYOR MEMET SASTRAWIRYA NO 01 BOOM BARU

712840

DR DEDY NUGROHO

PER/01/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2017

3

1500000001101

UPTD BLK INDUSTRI DISNAKERTRANS

JL. RESIDEN H AMALUDDIN SAKO KENTEN

PER/02/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

KANTOR CABANG

NO

1

KODE PROVIDER

1400000000730

MA11222I

:

G02- KANTOR CABANG PANGKAL PINANG

NAMA PROVIDER

BPRB MEDIKA STANNIA

ALAMAT

BELINYU

KODE POS

IKS TELEPON

PIMPINAN NO IKS YAYASAN BAKTI TIMAH

PER/001/122015



AWAL IKS 29/01/2016


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

2

1500000000133

KLINIK BAKTI TIMAH PARIT TIGA

JL. RAYA PARIT TIGA

351143

YAYASAN BAKTI TIMAH

PER/002/122015

RS.TRAUMA CENTRE

29/01/2016

29/02/2016

3

1500000000130

KLINIK BAKTI TIMAH TANJUNGPANDAN

JL. MELATI NO. 23 TANJUNGPANDAN

21865

YAYASAN BAKTI TIMAH

PER/002/122015

RS.TRAUMA CENTRE

29/01/2016

29/02/2016

4

1500000000131

KLINIK BAKTI TIMAH TOBOALI

JL. JEND. SUDIRMAN 227 TOBOALI

41771

YAYASAN BAKTI TIMAH

PER/002/122015

RS.TRAUMA CENTRE

29/01/2016

29/02/2016

5

1500000000132

RS BAKTI TIMAH MUNTOK

JL. RAYA TIMAH KOMPLEK PUSMET MUNTOK

21008

YAYASAN BAKTI TIMAH

PER/002/122015

RS.TRAUMA CENTRE

29/01/2016

29/02/2016

6

1400000000299

RSUD KABUPATEN BANGKA SELATAN

PER/09/052016

RS.TRAUMA CENTRE

01/05/2016

30/01/2017

7

1400000000729

RUMAH SAKIT MEDIKA STANNIA

PER/001/122015

RS.TRAUMA CENTRE

29/01/2016

29/02/2016

KANTOR CABANG

NO

KODE PROVIDER

:

266656700

JL. JEND. SUDIRMAN NO. 03 SUNGAILIAT

95837

YAYASAN BAKTI TIMAH

G03- KANTOR CABANG MUARA ENIM

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000001268

BALAI LATIHAN KERJA KAB.MUARA ENIM

JALAN PETROSIA III MUARA ENIM

KAB MUARA ENIM

PER/01/012016

RS.TRAUMA CENTRE

08/05/2016

28/01/2017

2

1500000001268

BALAI LATIHAN KERJA KAB.MUARA ENIM

JALAN PETROSIA III MUARA ENIM

KAB MUARA ENIM

PER/01/012016

RS.TRAUMA CENTRE

10/03/2016

28/01/2017

3

1500000001202

BALAI LATIHAN KERJA KOTA PRABUMULIH

JL JEND SUDIRMAN KM 35

KOTA PRABUMULIH

PER/42/062015

RS.TRAUMA CENTRE

10/03/2016

28/01/2017

MA11222I

320618


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

4

1500000000763

KLINIK FADHILAH

PT TEL DI DESA NIRU KEC RAMBANG DANGKU

24102380

RS FADHILAH

PER/28/042014

RS.TRAUMA CENTRE

10/03/2016

25/01/2017

5

1500000000764

KLINIK FCM 24 JAM

JL PADAT KARYA KELURAHAN GUNUNG IBUL

68044521

DR TRISNAYANTI

PER/29/042015

RS.TRAUMA CENTRE

10/03/2016

25/01/2017

6

7-3100567197

PUSKESMAS PULAU PANGGUNG

JL SERSAN M. BAHTIAR NO. 92,

NURHAYANI

PER/16/032016

RS.TRAUMA CENTRE

26/04/2016

01/03/2017

7

1500000001231

PUSKESMAS TANJUNG RAYA

DS TANJUNG RAYA KEC SEMENDO DARAT TENGAH

73720427

MUARA ENIM

PER/45/062015

RS.TRAUMA CENTRE

17/03/2016

25/01/2017

8

1500000000599

RS AR BUNDA PRABUMULIH

JL ANGKATAN 45 NO 525 KELURAHAN GUNUNG IBUL

322954

DR H ALIP YANSON

PER/19/042015

RS.TRAUMA CENTRE

10/03/2016

25/01/2017

9

1400000000192

RS PERTAMINA PRABUMULIH

JL. KESEHATAN NO. 100 KOMPERTA PRABUMULIH

382742

PT. PERTAMINA BINA MEDIKA

PER/21/04/2015

RS.TRAUMA CENTRE

05/04/2016

25/01/2017

10

1400000000122

RSUD HM RABAIN

SULTAN MAHMUD BADARUDIN II NO. 49

424345

PER/12/012016

RS.TRAUMA CENTRE

10/03/2016

25/01/2017

11

1500000000640

RSUD PRABUMULIH

JL LINGKAR KEL GUNUNG IBUL PRABUMULIH TIMUR

7001085

KOTA BRABUMULIH

PER/26/042016

RS.TRAUMA CENTRE

10/03/2016

25/01/2017

12

1500000000691

RSUD TALANG UBI

JL TAMAN SISWA KELURAHAN PASAR BHAYANGKARA, KECAMATAN TALANG UBI

390487

PENUKAL ABAB LEMATANG ILIR

PER/24/042015

RS.TRAUMA CENTRE

15/03/2016

25/01/2017

KANTOR CABANG

MA11222I

:

31356

H00- KANTOR CABANG BANDAR LAMPUNG


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1400000000503

KLINIK KOSASIH AMANAH

JL. IKAN KEMBUNG NO. 70 A TELUK BETUNG BANDAR LAMPUNG

35223

7175938

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

PER/25/112015

RS.TRAUMA CENTRE

04/01/2016

30/11/2016

2

1400000000500

KLINIK KOSASIH KEMILING

JL. TEUKU CIK DITIRO BLOK E NO. 4 KEMILING BANDAR LAMPUNG

35158

3540424


PER/22/112015

RS.TRAUMA CENTRE

04/01/2016

30/11/2016

3

1400000000504

KLINIK KOSASIH PALAPA

JL. CUT NYAK DIEN NO. 62 PALAPA BANDAR LAMPUNG

35116

7140218


PER/26/112015

RS.TRAUMA CENTRE

04/01/2016

30/11/2016

4

1400000000507

KLINIK KOSASIH PANJANG

JL. TANJUNG PURA II NO. 50 PANJANG UTARA BANDAR LAMPUNG

9761738


PER/28/112015

RS.TRAUMA CENTRE

04/01/2016

30/11/2016

5

1400000000498

KLINIK KOSASIH SUMBER WARAS

JL. RAYA GADING REJO NO. 221 GADING REJO

7910645


PER/20/112015

RS.TRAUMA CENTRE

04/01/2016

30/11/2016

6

1400000000508

KLINIK KOSASIH TANJUNGAN

JL. LINTAS SUMATERA SIMPANG KATES TANJUNG AGUNG LAMPUNG SELATAN

7773665


PER/29/112015

RS.TRAUMA CENTRE

04/01/2016

30/11/2016

7

1400000000501

KLINIK KOSASIH TELUK

JL. IKAN SALEM NO. 05 TELUK BETUNG BANDAR LAMPUNG

7641529


PER/23/112015

RS.TRAUMA CENTRE

04/01/2016

30/11/2016

8

1400000000502

KLINIK KOSASIH TIRTAYASA

JL. PANGERAN TIRTAYASA NO. 181 SUKABUMI BANDAR LAMPUNG

7167635


PER/24/112015

RS.TRAUMA CENTRE

04/01/2016

30/11/2016

9

1400000000499

KLINIK MITRA KOSASIH

JL. MS. BATUBARA NO. 70 KUPANG TEBA TELUK BETUNG BANDAR LAMPUNG

7327768


PER/21/112015

RS.TRAUMA CENTRE

04/01/2016

30/11/2016

10

1400000000497

KLINIK RAWAT INAP KOSASIH RAJABASA

JL. KAPTEN ABDUL HAQ NO 9/31 RAJABASA

7511491


PER/19/112015

RS.TRAUMA CENTRE

04/01/2016

30/11/2016

11

1400000000505

KLINIK RAWAT INAP KOSASIH TUGU

JL. KAPTEN HAYAM WURUK NO. 20 TANJUNG KARANG TIMUR

7365397


PER/27/112015

RS.TRAUMA CENTRE

04/01/2016

30/11/2016

12

1400000000496

KLINIK RAWAT INAP KOSASIH URIP

JL URIP SUMOHARJO NO 176 KEDATON

3526413


PER/18/112015

RS.TRAUMA CENTRE

04/01/2016

30/11/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

13

1500000000181

RS GLADISH MEDICAL CENTER

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

14

1500000000253

RS MUHAMMADIYAH METRO

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

15

1500000000209

RS NATAR MEDIKA

16

1500000000218

17

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

CV GLADISH MEDICAL CENTER

PER/04/022016

RS.TRAUMA CENTRE

10/02/2016

31/01/2017

7008000

PERSYARIKATAN MUHAMMADIYAH

PER/09/022016

RS.TRAUMA CENTRE

28/03/2016

28/02/2017

JL. RAYA NATAR NOMOR 4 MUARA PUTIH

92521

YAYASAN ABDI KARYA

PER/05/022016

RS.TRAUMA CENTRE

10/02/2016

31/01/2017

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

1400000000116

RS URIP SUMOHARJO

JL URIP SUMOHARJO NO 200 SUKARAME

771322

PT GUNUNG SULAH MEDIKA

PER/07/022016

RS.TRAUMA CENTRE

16/03/2016

28/02/2017

18

1500000000115

RS WISMA RINI

JL. WISMA RINI NO. 01 PRINGSEWU

21582

YAYASAN BUDI SETIA BHAKTI

PER/01/022016

RS.TRAUMA CENTRE

10/02/2016

31/01/2017

19

1500000000165

RSUD DR. H. ABDUL MOELOEK PROVINSI LAMPUNG

JALAN DR. RIVAI NOMOR 06 PENENGAHAN

703312

PROVINSI LAMPUNG

PER/05/012015

RS.TRAUMA CENTRE

10/02/2016

31/01/2017

20

1400000000471

RSUD DR. H. BOB BAZAR, SKM

JALAN LETTU ROHANI NOMOR 14B KALIANDA

322160

PER/30/112015

RS.TRAUMA CENTRE

04/01/2016

30/11/2016

21

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

22

1500000000134

RSUD PESAWARAN


KABUPATEN PESAWARAN

PER/03/012015

RS.TRAUMA CENTRE

10/02/2016

31/01/2016

23

1500000000134

RSUD PESAWARAN


KABUPATEN PESAWARAN

PER/02/022016

RS.TRAUMA CENTRE

10/02/2016

31/01/2017

24

1500000000427

UPTD BALAI LATIHAN KERJA BANDAR LAMPUNG

JL. PAGAR ALAM NOMOR 127 BANDAR LAMPUNG

DINAS TENAGA KERJA DAN TRANSMIGRASI PROVINSI LAMPUNG

PER/06/022016

RS.TRAUMA CENTRE

28/03/2016

28/02/2017

MA11222I


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NO

:

KODE PROVIDER

H01- KANTOR CABANG LAMPUNG TENGAH

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

7-2738805337

KLINIK 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

2

1500000000318

RS ISLAM ASY-SYIFAA

JL. LINTAS SUMATRA KM 65 BANDAR JAYA

34163

DR. JOSI HARNOS

PER/004/032016

RS.TRAUMA CENTRE

07/03/2016

01/03/2017

3

7-1568007187

RS YUKUM MEDICAL CENTRE

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

34163

PT. MITRA MEDICAL CENTER

PER/002/012016

RS.TRAUMA CENTRE

22/02/2016

31/01/2017

KANTOR CABANG

NO

KODE PROVIDER

:

J00- KANTOR CABANG JAKARTA SALEMBA

NAMA PROVIDER

ALAMAT

1

1500000001278

KLINIK PERTAMEDIKA

JL. PERWIRA NO.2-4 KEL. GAMBIR KEC. GAMBIR JAKARTA PUSAT

2

1400000000304

KLINIK SUMBER SEHAT

JL. PERCETAKAN NEGARA 2 BLOK J NO. 1415, KELURAHAN JOHAR BARU

3

1500000000328

RS MH THAMRIN SALEMBA

JALAN SALEMBA TENGAH NO 24 -28 JAKARTA PUSAT

4

1400000000298

RS PERTAMINA JAYA

JL.JEND.ACHMAD YANI NO 2 CEMPAKA PUTIH

5

1400000000658

RS RIDWAN MAUREKSA

6

1400000000351

RSIA EVASARI

MA11222I

072525333

JL. RAWAMANGUN NO. 27 PRAMUKA JAKARTA PUSAT 10570

KODE POS

IKS TELEPON

PIMPINAN NO IKS

4240700

4211911

4202851

TIPE IKS

AWAL IKS

AKHIR IKS

DR NENY HERAWATI

PER/84/042016

RS.TRAUMA CENTRE

13/05/2016

31/03/2017

DR EDI SETIAWAN

PER/03/012016

RS.TRAUMA CENTRE

28/03/2016

31/12/2016

DR MIRA ROZIATI DACHLAN

PER/79/032016

RS.TRAUMA CENTRE

20/04/2016

28/02/2017

PER/01/012016

RS.TRAUMA CENTRE

05/01/2016

31/12/2016

PER/62/122015

RS.TRAUMA CENTRE

14/03/2016

30/11/2016

PER/02/012016

RS.TRAUMA CENTRE

05/01/2016

31/12/2016


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NO

:

KODE PROVIDER

J02- KANTOR CABANG JAKARTA GROGOL

NAMA PROVIDER

ALAMAT

KODE POS

7-2354876841

RSTC DUTA INDAH

JL TELUK GONG RAYA NO 12

2

1500000000516

RSTC MEDIKA PERMATA HIJAU

JL RAYA KEBAYORAN LAMA NO.64 JAKARTA BARAT

5347411

3

1500000000088

RSTC ROYAL TARUMA

JL DAAN MOGOT NO 34 JAKARTA

56967788

4

7-2617918393

RSTC SUMBER WARAS

JL KYAI TAPA NO.1 TOMANG, GROGOL PETAMBURAN, JAKARTA BARAT

0215682011

NO

:

KODE PROVIDER

11440

NAMA PROVIDER

ALAMAT

KODE POS

7-2942035683

RUMAH SAKIT PELABUHAN JAKARTA

JL.KRAMAT JAYA TANJUNG PRIOK

14310

2

7-2307624884

RUMAH SAKIT SATYA NEGARA

JALAN AGUNG UTARA RAYA BLOK A NO.1 JAKARTA UTARA

14350

MA11222I

:

66676188

TIPE IKS

AWAL IKS

AKHIR IKS

PER/05/032016

RS.TRAUMA CENTRE

07/03/2016

28/02/2017

PER/07/032016

RS.TRAUMA CENTRE

14/03/2016

28/02/2017

DR. LIMAN HARIJONO, MARS

PER/06/032016

RS.TRAUMA CENTRE

14/03/2016

28/02/2017

YAYASAN RS SUMBER WARAS

PER/04/032016

RS.TRAUMA CENTRE

22/03/2016

28/02/2017

PT DUTA INDAH MEDIKA

J03- KANTOR CABANG JAKARTA KELAPA GADING

1

KANTOR CABANG

PIMPINAN NO IKS

1

KANTOR CABANG

14450

IKS TELEPON

IKS TELEPON

PIMPINAN NO IKS

64715200

TIPE IKS

AWAL IKS

AKHIR IKS

DR.M.SYAIFUL HUDA EFFENDI,M.M

PER/10/122015

RS.TRAUMA CENTRE

15/04/2016

30/11/2016

DR. SANTOSO KURNIAWAN

PER/06/062015

RS.TRAUMA CENTRE

29/02/2016

30/04/2016

J04- KANTOR CABANG JAKARTA RAWAMANGUN


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NO

1

KODE PROVIDER

7-1669163483

KANTOR CABANG

NO

NAMA PROVIDER

RSTC OMNI PULOMAS

:

KODE PROVIDER

ALAMAT

JL. PULOMAS BARAT VI NO.20, JAKARTA TIMUR

KODE POS

13210

IKS TELEPON

PIMPINAN NO IKS

2977 9999

DR MARIA

PER/01/012016

TIPE IKS

AWAL IKS

RS.TRAUMA CENTRE

01/02/2016


J06- KANTOR CABANG JAKARTA CILANDAK

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000170

KLINIK ARAS

JL SRENGSENG SAWAH RT 001/009 JAGAKARSA

7869916

DR. SERI ANNI NASUTION

PER/01/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

2

1500000000839

PPKD JAKARTA SELATAN

JL BUNCIT RAYA NO 440 MAMPANG

7980311

LETTY LESTARI

PER/03/052016

RS.TRAUMA CENTRE

02/05/2016

31/07/2016

3

1500000001524

RS FATMAWATI

DI JL RS FATMAWATI CILANDAK

7501524

DR.ANDI WAHYUNINGSIH ATTAS

PER/14/052015

RS.TRAUMA CENTRE

28/04/2016

30/04/2016

4

1500000001524

RS FATMAWATI

DI JL RS FATMAWATI CILANDAK

7501524

DR.ANDI WAHYUNINGSIH ATTAS

PER/01/05/2016

RS.TRAUMA CENTRE

02/05/2016

31/07/2016

5

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

6

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

7

7-3320778960

RS SETIA MITRA

JL RS FATMAWATI NO 80-82

DR SARASWATI

PER/05/052016

RS.TRAUMA CENTRE

20/05/2016

20/04/2018

KANTOR CABANG

MA11222I

:

12790

J07- KANTOR CABANG JAKARTA GAMBIR


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

1

7-2457507777

RS TARAKAN

JL. KYAI CARINGIN NO.7 JAKARTA PUSAT

2

1500000001453

RUMAH SAKIT HUSADA

JLN. RAYA MANGGA BESAR NO.137-139 JAKARTA PUSAT 10730

KANTOR CABANG

NO

:

KODE PROVIDER

KODE POS

10150

IKS TELEPON

PIMPINAN NO IKS

3503150000

DR. TOGI ASMAN SINAGA MKES

6260108

TIPE IKS

AWAL IKS

AKHIR IKS

PER/02/2016

RS.TRAUMA CENTRE

14/03/2016

31/12/2017

PER/10/062016

RS.TRAUMA CENTRE

01/06/2016

31/05/2017

J09- KANTOR CABANG JAKARTA CAWANG

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

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

2

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

KANTOR CABANG

NO

1

:

KODE PROVIDER

NAMA PROVIDER

1400000000303

KANTOR CABANG

MA11222I

J0P- KANTOR CABANG JAKARTA SLIPI

RS PELNI

:

ALAMAT

JL AIPDA KS TUBUN 92-94

KODE POS

10210

IKS TELEPON

PIMPINAN NO IKS

5485870

PT PELNI

PER/09/092015


AWAL IKS 27/01/2016


J11- KANTOR CABANG TANGERANG BATUCEPER


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

NO IKS

1

1500000000145

KLINIK PRATAMA MH THAMRIN CENGKARENG

JL DAAN MOGOT KM 17 NO 69 RT02/04 KLDRS

2

7-2709100583

KLINIK SEMANAN

JL SEMANAN RAYA NO 23 RT 001/002

11720

3

7-1459450363

RS HERMINA DAAN MOGOT

JL KINTAMANI RAYA NO 2 DAAN MOGOT BARU

11710

4

1500000000146

RS KARANG TENGAH MEDIKA

JL KARYAWAN IV CILEDUG KARANG TENGAH

7336699

5

1500000001260

RS MITRA HUSADA

JL KAMPUNG MELAYU BARAT NO 11 A TELUK NAGA

082125449 938

6

7-3175908453

RSK DR SITANALA TANGERANG

JL DR SITANALA NO 99 KOTA TANGERANG

KANTOR CABANG

NO

1

:

KODE PROVIDER

KANTOR CABANG

MA11222I

RS ANTAM MEDIKA

:

15211

TIPE IKS

AWAL IKS

AKHIR IKS

PER/003/012016

RS.TRAUMA CENTRE

01/02/2016

31/01/2017

DR JOHAN

PER/008/032016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

DR I ICHSAN HANAFI MARS

PER/004/012016

RS.TRAUMA CENTRE

22/01/2016

17/01/2017

PER/005/012016

RS.TRAUMA CENTRE

01/02/2016

31/01/2017

DR HENDRY WIJAYA

PER/014/052016

RS.TRAUMA CENTRE

02/05/2016

30/04/2017

DR ALI MUCHTAR SP PK MARS

PER/013/052016

RS.TRAUMA CENTRE

02/05/2016

30/04/2017

J12- KANTOR CABANG JAKARTA PULOGADUNG

NAMA PROVIDER

1500000000247

PIMPINAN

ALAMAT

JL RAYA PEMUDA NO 1A

KODE POS

IKS TELEPON

PIMPINAN NO IKS

29378939

PER /08/032016


AWAL IKS 15/03/2016


J13- KANTOR CABANG JAKARTA KEBAYORAN BARU


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NO

1

KODE PROVIDER

1500000000476

KANTOR CABANG

NO

1

RS GANDARIA

:

KODE PROVIDER

KODE PROVIDER

RS ZAHIRAH

:

ALAMAT

KODE POS

JLN GANDARIA TENGAH II NO 6-14 JAK SEL

IKS TELEPON

PIMPINAN NO IKS

7203311

DR .H.J ROESLANI S,SP THT

PER/01/042016

TIPE IKS

AWAL IKS

RS.TRAUMA CENTRE

20/04/2016


J17- KANTOR CABANG JAKARTA MAMPANG

NAMA PROVIDER

1806201500004

KANTOR CABANG

NO

NAMA PROVIDER

ALAMAT

KODE POS

JL. SIRSAK NO.21 JAGAKARSA JAKARTA SELATAN

IKS TELEPON

PIMPINAN NO IKS

7872210

ROBI HARI SETIAWAN,SE,MM

PER/04/032016

TIPE IKS

AWAL IKS

RS.TRAUMA CENTRE

01/06/2016


K00- KANTOR CABANG BANDUNG SUCI

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

7271451

NENDEN SUHARTINI

PER/01/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

JL. CIHAMPELAS 7 BANDUNG

4201596

PT KIMIA FARMA (PERSERO) TBK

PER/09/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

KLINIK KIMIA FARMA 51

JL.IR.H.JUANDA 69 BANDUNG

4203331


PER/11/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

1500000000835

KLINIK KIMIA FARMA SETIABUDI

JL.SETIABUDI 36 BANDUNG

2038048


PER/12/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

1500000000836

KLINIK KIMIA FARMA SINDANGLAYA

JL. SUKAMISKIN 126B BANDUNG

7178664


PER/13/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

1

1500000001896

BIOFIT HEALTH CENTER

JL. WR SUPRATMAN NO. 69, BANDUNG

2

1500000000837


3

1500000000834

4

5

MA11222I

40114


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

6

1500000000859

KLINIK ALIVIA MEDIKA

JL. PASUNDAN NO. 107, BANDUNG

87805328

YUDI PRIHARTANTO

PER/02/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

7

1500000000860

KLINIK AMANAH

JL. PHH MUSTOFA NO. 124, BANDUNG.

7279705

YUDI PRIHARTANTO

PER/03/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

8

1500000000805

KLINIK BINA MASYARAKAT SEHAT (BMS)

JL. AH NASUTION NO. 96 A BANDUNG

7801861

DR H YONO SUDIYONO MARS, MHKES

PER/04/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

9

1500000000855

KLINIK HIKMAH

JL. PESANTREN NO. 8A, RT 01/04, KELURAHAN SUKAMISKIN, KECAMATAN ARCAMANIK, BANDUNG

814 254 80

DRG NIA LESTARI

PER/05/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

10

1500000000854

KLINIK HIKMAH DUA

JL. IBRAHIM AJI NO. 145, KIARA CONDONG, BANDUNG

81525480

NANO ROHANA

PER/06/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

11

1500000000585

KLINIK ITENAS

JALAN PHH MUSTOFA NO. 23 , BANDUNG

PT. RS PADJADJARAN

PER/07/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

12

1500000000584

KLINIK KIARA HUSADA

JALAN IBRAHIM ADJIE NO. 25 (TERS KIRCON) BANDUNG

7564929

PT RUMAH SAKIT PADJADJARAN

PER/08/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

13

1500000000833


JL. BUAH BATU 59 BANDUNG

7305019


PER/10/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

14

1500000000553

KLINIK MITRA MULYA

JL. AH NASUTION NO. 20 RT 001/014, CIPADUNG KIDUL, PANYILEUKAN, BANDUNG

7804489

MULYATI

PER/14/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

15

1500000000704

KLINIK PRATAMA SEHATI

RUKO BUMI MAS KENCANA KAV O. JL. AH NASUTION 928, CIKADUT, BANDUNG

7237337

DRG YUDHIASTUTI NUNING HARINI

PER/15/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

16

1500000000600

KLINIK PRATAMA SELAMAT

JL. TERUSAN BUAH BATU NO. 227 BANDUNG

88881585

DR MAGDALIZA

PER/16/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

17

1500000000853

KLINIK UJUNG BERUNG

JL. RUMAH SAKIT NO.5 RT. 006/07, PAKEMITAN, CINAMBO, BANDUNG

91752269

DR HARIS FATAH

PER/17/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

18

1500000000743

KLINIK UTAMA AL ISLAM

JL. AWIBITUNG NO. 29-31 CICADAS BANDUNG

7208284

YAYASAN RUMAH SAKIT ISLAM-KSWI JAWA BARAT

PER/18/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

19

1500000000708

KLINIK UTAMA MEDIKA ANTAPANI

JALAN PURWAKARTA NO.3 ANTAPANI BANDUNG

081563944 143

DRA HJ LENTE MELANIE

PER/19/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

20

1500000000801

RS MATA CICENDO

JL. CICENDO NO. 4 BANDUNG

4231280

KEMENKES

PER/20/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

21

1100000000014

RS PINDAD

JL. GATOT SUBROTO NO.517 PAPANGGUNGAN BANDUNG

7322468

PER/21/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

22

1100000000015

RS SARININGSIH

JL. LL RE MARTADINATA NO. 9

PER/22/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

23

1500000001399

RS. SALAMUN

JL. CIUMBELUIT NO. 203, BANDUNG, JAWA BARAT, 40142

24

1500000001934

RSKB HALMAHERA SIAGA

JL.L.L.R.E.MARTADINATA NO.28, JAWA BARAT 40115

25

1500000000697

RSU BUNGSU

JL. VETERAN NO. 6, BANDUNG

26

7-2299406693

RSU HERMINA ARCAMANIK

JL. A H NASUTION NO. 50 BANDUNG, JAWA BARAT, 40291

27

1500000000460

RSUD KOTA BANDUNG

JL. RUMAH SAKIT NO. 22, UJUNGBERUNG

28

1500000001936

RSUP HASAN SADIKIN BANDUNG

JL. RAYA PASTEUR NO 36, BANDUNG

KANTOR CABANG

MA11222I

:

40115

40291

2032090

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

PER/23/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

4206061

PROF DR M AHMAD DJOJOSUGITO, DR, SP OT

PER/24/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

4231550

DR. LILIAN MELATTIE E. NORE

PER/25/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

87242525

DR. TOMMY JOESOEF

PER/25/012016

RS.TRAUMA CENTRE

01/03/2016

31/12/2016

PER/26/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

PER/27/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

7811794

40161

2034953

KEMENKES

K01- KANTOR CABANG BEKASI KOTA


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

1

1500000000698

KLINIIK TC ANNISA

JL RAYA KAMPUNG BARU KEMANG RT 03/04 JATIBENING BARU PD GEDE BEKASI

2

1500000000830

KLINIK TC CAHAYA ASYPA

TAMAN NAROGONG INDAH BLOK C.18 NO 1

3

1500000000699

KLINIK TC HANDAYANI MEDIKA

4

1500000000744

5

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

PER/17/052015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

PER/24/052015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

JL RAYA KALIMALANG NO 9 DS CIBUNTU CIBITUNG BEKASI

PER/18/052015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

KLINIK TC MAHADINA

JL RAYA SELANG JATI RT 03/03 WANAJAYA CIBITUNG

PER/22/052015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

1500000000913

KLINIK TC MH THAMRIN BEKASI

JL HM JOYOMARTONO NO 31B BEKASI TIMUR

PER/25/052015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

6

1500000001328

KLINIK TC SETO HASBADI 01

JL SEROJA NO 10A KA CEGER RT 06/02 HARAPAN JAYA

PER/30A/062015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

7

1500000001327


JL RAYA SULTAN AGUNG BLOK O NO 27 MEDAN SATRIA

PER/30B/062015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

8

1500000001326


JL RAYA IMAM BONJOL NO 01 TELAGA ASIH CIKARANG BARAT

PER/30C/062015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

9

1500000001254

KLINIK TC SRITINA

JL IMAM BONJOL NO 8 RT 01/01 TELAGA MURNI CIKARANG BARAT

PER/28/062015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

10

7-3241314323

RS ANNA MEDIKA

JL RAYA PERJUANGAN NO 45 HARAPAN BARU BEKASI

11

1400000000121

RSTC CIBITUNG MEDIKA

12

1400000000121

RSTC CIBITUNG MEDIKA

MA11222I

ALAN

88882211

PT ANNA MEDIKA

PER/05/052016

RS.TRAUMA CENTRE

11/05/2016

31/12/2016

J LRAYA BOSIH NO.117 CIBITUNG

88323444

PT ADHI PUTRA MEDIKA

PER/01/012016

RS.TRAUMA CENTRE

09/02/2016

31/12/2016

J LRAYA BOSIH NO.117 CIBITUNG

88323444

PT ADHI PUTRA MEDIKA

PER/19/052015

RS.TRAUMA CENTRE

04/01/2016

31/12/2015

17121


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

13

1100000000020

RSTC HOSANA MEDICA

JL PRAMUKA NO.12 RAWA LUMBU NAROGONG

8221570

JOHANES POSO

PER/27/062015

RS.TRAUMA CENTRE

04/01/2016

31/12/2015

14

1100000000020

RSTC HOSANA MEDICA

JL PRAMUKA NO.12 RAWA LUMBU NAROGONG

8221570

JOHANES POSO

PER/02/012016

RS.TRAUMA CENTRE

09/02/2016

31/12/2016

KANTOR CABANG

NO

KODE PROVIDER

:

K02- KANTOR CABANG BOGOR KOTA

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000252

BATIK MEDICAL CENTER

JL KAYUMANIS NO 09 RT 02/ 01 KEL CIBINONG

295333182

CV BATIK ESTETIKA INDONESIA

PER/16/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

2

1400000000415

BP BUNDA MULIA

JL SOMANTRI NO 11 RT 003/004 DS MEKAR MULYA PARUNG PANJANG

5978058

HJ UPEN SUPENTI

PER/07/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

3

1500000000073

BP NURDIN WAHID

JL HM ASHARI NO 22 CIBINONG

87916739

YANNI MAUTIA S R

PER/12/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

4

7-1588689223

KLINIK AULIA MEDIKA

JL.LANDBAW NO.01

16810

87902900

SUSINAH HARUN

PER/22/012016

RS.TRAUMA CENTRE

04/02/2016

31/12/2016

5

7-1588689227

KLINIK MH THAMRIN

JL.RAYA PUNCAK KM 75 CIPAYUNG

16770

025182561 72

YAYASAN MH THAMRIN

PER/25/012016

RS.TRAUMA CENTRE

04/02/2016

31/12/2016

6

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

7

7-1670259391

KLINIK PERMATA HUSADA

JL.RAYA BABAKAN MADANG NO.10

DRG.WIWIK DWI ARYANI, MARS

PER/24/012016

RS.TRAUMA CENTRE

04/02/2016

31/12/2016

MA11222I

16810

87952811


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

8

1500000001536

PUSKESMAS JASINGA

JL.LET.SAYUTI JASINGA

085780041 002

9

1400000000310

RS ATANG SANJAYA

JL SARIJO NO 1 ATANG SANJAYA KEMANG

7532946

10

1500000000314

RS BHAYANGKARA TK IV BOGOR

JALAN KAPTEN MUSLIHAT NO 18

11

1200000000006

RS BINA HUSADA TC

JL MAYOR OKING JAYAATMAJA

12

1500000000071

RS FAMILY MEDICAL CENTER TC

JL RAYA JAKARTA BOGOR KM 51 SUKARAJA

13

1400000000286

RS ISLAM BOGOR

JALAN PERDANA RAYA NO 22

14

1400000000284

RS KARYA BHAKTI PRATIWI

15

1400000000713

16

TIPE IKS

AWAL IKS

AKHIR IKS

PER/21/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

AURI

PER/04/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

8348987

POLRI

PER/17/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

87911000

DR HARSONO

PER/01/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

PT JALAMAS PUTRA REJEKI

PER/10/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

8316822

YYS RS ISLAM BOGOR

PER/26/012016

RS.TRAUMA CENTRE

29/01/2016

31/12/2016

JALAN RAYA DRAMAGA KM 7

8626868

YYS KARYA BHAKTI PRATIWI

PER/02/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

RS MELANIA

JALAN PAHLAWAN NO 91 BOGOR SELATAN

8321196

PT SPAA MEDIKA

PER/09/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

1500000000074

RS PMI BOGOR TC

JL PAJAJARAN NO 80

YAYASAN PMI

PER/13/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

17

1400000000309

RS SALAK BOGOR

JL JENDRAL SUDIRMAN NO 8

8344609

KESDAM SILIWANGI

PER/03/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

18

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

19

1400000000333

RS TRIMITRA

JL RAYA JAKARTA BOGOR KM 43 CIBINONG

8763055

DR EMA SUMARSAH

PER/05/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

20

1500000000637

RS VANIA

JL SILIWANGI NO 11 KEL SUKASARI BOGOR TIMUR

21

1500000000075

RSD CIBINONG TC

JL DESA TENGAH NO 27 CIBINONG

22

1500000000636

RSIA ANNISA

JL RAYA KARANGGAN NO 2 DS PUSPASARI CITEUREUP

23

1500000001535

RSUD CIAWI BOGOR

JL.RAYA PUNCAK NO.479 CIAWI

24

1400000000442

RSUD KOTA BOGOR

JALAN RAYA SUMERU NO 120

25

1500000000230

RUMAH SAKIT PERTAMEDIKA SENTUL CITY

JL MH THAMRIN NO.1 SENTUL CITY BOGOR

26

1400000000414

SALSABILLA MEDICAL CENTRE

JL KSR DADI KUSMAYADI RUKO LMC NO 70 CIKARET CIBINONG

KANTOR CABANG

NO

KODE PROVIDER

:

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

PER/19/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

PEMDA KAB BOGOR

PER/14/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

YYS ANNISA

PER/18/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

PER/20/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

DR TRIWANDHA ELAN

PER/08/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

29672977

KWEE LIANA KUMALA

PER/15/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

87905768

DR WAHYU EKO W, SPOT

PER/06/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

081211012 84

K04- KANTOR CABANG TANGERANG CIKOKOL

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000001159

MAYAPADA HOSPITAL TANGERANG

JL. HONORIS RAYA KAV. 6, KOTA MODERN TANGERANG

55781888

DR. DEDI TEDJAKUSNADI, MARS

PER/68/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

2

1400000000650

RS BHAKTI 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

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

3

1400000000652

RS. SARI ASIH CILEDUG

JL HOS COKROAMINOTO NO 38 CILEDUG

7333430

PT. SARI ASIH PUTRA MANDIRI, DICKY R H PAMUNGKAS

PER/66/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

4

1400000000651

RS. SARI ASIH KARAWACI

JL. IMAM BONJOL NO.38

5522794

PT. SARI ASIH PUTRA MANDIRI, DICKY R H PAMUNGKAS

PER/65/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

5

1400000000655

RS. SILOAM HOSPITALS LIPPO VILLAGE

JL. SILOAM NO 6 LIPPO VILLAGE TANGERANG

5460055

PT. SILOAM INTERNATIONAL HOSPITALS

PER/69/122015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

6

1500000000465

RS. USADA INSANI

JL. K.H HASYM ASHARI NO. 24 TANGERANG

55752575

PT. SURYA MITRA INSANI

PER/64/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

1500000000017

RSU KABUPATEN TANGERANG

JL JEND AHMAD YANI NO 9 TANGERANG 15111

5523507

PEMDA KABUPATEN TANGERANG

PER/73/122015

RS.TRAUMA CENTRE

19/04/2016

31/12/2016

KANTOR CABANG

NO

KODE PROVIDER

:

K05- KANTOR CABANG SERANG

NAMA PROVIDER

ALAMAT

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

WAWAN MULYANA

PER/07/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

085254259 386

DRG. DIAN KIBLATI

PER/078/062015

RS.TRAUMA CENTRE

01/05/2016

31/05/2016

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

JL JEND AHAMD YANI NO.56

209975

DR. DIANAHAN

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

1

1500000000330

BP PERMATA HUSADA

JL LETJEND SUPRAPTO NO 45 CILEGON

2

1500000001467

KLINIK DJASARI MEDIKA CURUG

KP.TINGGAR RT 03/02 DS.SUKALAKSANA KEC.CURUG

3

1500000000331

KLINIK ISNA MEDIKA

4

1500000000254

KLINIK MEDIKA

MA11222I

KODE POS


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

5

1500000000107

KLINIK MODERN MEDIKA CIKANDE

RUKO B6 KOMP MODERN INDUSTRI CIKANDE JL RAYA SERANG KM 68

400554

PT MODERN MEDIKA

PER/03/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

6

1500000000255

KLINIK SERANG MEDIKA

JL RAYA SERANG CILEGON RUKO LEGOK SUKMAJAYA BLOK 5C NO. 1

223992

DR RINA NOVIA SP.AN

PER/06/032015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

1500000000329

RS HERMINA CIRUAS

JL RAYA SERANG JAKARTA KM 9 CIRUAS

280555

HERMINA HOSPITAL GROUP

PER/09/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

8

7-3071694287

RS KRAKATAU MEDIKA

JL SEMANG RAYA

025439745 6

PT KRAKATAU MEDIKA

PER/03/022016

RS.TRAUMA CENTRE

26/04/2016

31/01/2017

9

1500000000086

RS SARI ASIH SERANG

JL JEND SUDIRMAN NO 38 SERANG

220022

PT SARI ASIH ARIA CEMERLANG

PER/01/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

10

1400000000082

RSUD BANTEN

JL SYECH NAWAWI AL-BANTANI

8490911

PROVINSI BANTEN

PER/010/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

11

1500000000244

RSUD DR. ADJIDARMO

JL IKO DJATMIKO NO.1 RANGKASBITUNG

376433

RSUD ADJIDARMO

PER/04/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

12

1400000000320

RSUD SERANG

JL RUMAH SAKIT NO.1

200528

KOTA SERANG

PER/02/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

KANTOR CABANG

NO

1

KODE PROVIDER

1500000000059

MA11222I

:

42415

42111

K06- KANTOR CABANG SUKABUMI

NAMA PROVIDER

RS BETHA MEDIKA

ALAMAT

JL. RAYA CISAAT NO. 595

KODE POS

IKS TELEPON

PIMPINAN NO IKS

224128

PER/14/TC/12/20 15



AWAL IKS 01/01/2016


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

NO IKS

2

1400000000196

RS BHAKTI MEDICARE

JL. RAYA SILIWANGI NO. 186 B, CICURUG, KAB SUKABUMI

731555

3

1400000000531

RS KARTIKA MEDICAL CENTER

JL. JEND. A. YANI NO 18A

4

1400000000671

RSUD CIMACAN

JL. RAYA CIMACAN NO. 17 CIPANAS

5

1500000000060

RSUD PELABUHAN RATU

6

1500000000515

7

1500000000428

KANTOR CABANG

NO

1

:

KODE PROVIDER

KANTOR CABANG

MA11222I

AWAL IKS

AKHIR IKS

RS.TRAUMA CENTRE

01/05/2016

30/04/2018

6250902

PER/02/TC/0420 16

RS.TRAUMA CENTRE

04/04/2016

30/11/2017

512465

PER/15/TC/1220 15

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

JL. A. YANI NO. 2 PELABUHAN RATU

PER/20/TC/1220 15

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

RSUD R. SYAMSUDIN SH

JL. RUMAH SAKIT NO. 1

PER/01/TC/0420 16

RS.TRAUMA CENTRE

04/04/2016

31/03/2017

RUMKITBAN 03.08.01 PANGRANGO

JL. PGRI NO 8

PER/04/TC/0420 16

RS.TRAUMA CENTRE

04/04/2016

31/03/2018

SUPRIADI SETIAWAN

K07- KANTOR CABANG TASIKMALAYA

RUMAH SAKIT JASA KARTINI

:

TIPE IKS

PER/03/TC/0420 16

NAMA PROVIDER

1400000000593

PIMPINAN

ALAMAT

JL OTTO ISKANDARDINATA NO. 15

KODE POS

IKS TELEPON

PIMPINAN NO IKS

331808

PT. KARSA ABDI HUSADA

PER/68/122015


AWAL IKS 09/02/2016


K09- KANTOR CABANG PURWAKARTA


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KODE PROVIDER

NAMA PROVIDER

ALAMAT

1

1300000000035

RS. MH THAMRIN PURWAKARTA

JL. RAYA BUNGURSARI NO. 36 SADANG

2

1400000000434

RSUD BAYU ASIH

JL VETERAN NO 39

KANTOR CABANG

NO

KODE PROVIDER

:

KODE POS

IKS TELEPON

PIMPINAN NO IKS

8222222

DR.H. KEMAL MUHAMAD, MMR.,M.KES,AIFO

TIPE IKS

AWAL IKS

AKHIR IKS

PER/01/012016

RS.TRAUMA CENTRE

21/01/2016

31/12/2016

PER/20/102015

RS.TRAUMA CENTRE

21/01/2016

31/10/2016

K10- KANTOR CABANG KARAWANG

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000001517

KLINIK GRAHA MEDIS CILAMAYA

JL RAYA CILAMAYA DESA CILAMAYA WETAN KAB KARAWANG

340202

DR H. SUNUHARDO EP, M.KES

PER/11/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

2

1500000000409

KLINIK BHAKTI MEDIKA

JL AHMAD YANI NO 100 DAWUAN CIKAMPEK

8862936

MUHAMMAD SAFI'I MA'ARIF ,SE

PER/15/2016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

3

1500000000847

KLINIK BINA MEDIKA

JL RAYA TELUK JAMBE NO 5 DESA TELUK JAMBE

641968

SUDIARTO (08121918055)

PER/16/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

4

7-1372189411

KLINIK CURUG RAHAYU

KP KARAJAN 2 DS CURUG KEC KLARI

MARANTINO LUMMUSA

PER/24/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

5

1500000000846

KLINIK GEMPOL

JL RANGGA GEDE NO 29 GEMPOL KEL TANJUNG PURA KEC KARAWANG BARAT

02678453903

SUDIARTO (08121918055)

PER/17/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

6

1500000001515

KLINIK GRAHA MEDIS CIKAMPEK

JL A. YANI NO 51 DAWUAN TIMUR

310101

DR. HJ. DYAH PERMATA S.M.KES

PER/12/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

7

1500000001516

KLINIK GRAHA MEDIS KOPEL

JL RAYA KLARI DS KLAPANUNGGAL RT 26/07 GINTUNG KERTA KLARI

DR H DYAH PERMATA SURYARINI M.KES

PER/13/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

MA11222I

41371


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

8

1500000001518

KLINIK GRAHA MEDIS KOSAMBI

JL RAYA KOSAMBI NO 23 DESA DUREN KLARI

435527

DR.H. SUNUHARDO EP, M.KES

PER/14/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

9

1500000000843

KLINIK MITRA GEMPOL

JL PROKLAMASI NO 15 KW 8 RT 003/005 KEL TUNGGAK JATI KEC KARAWANG BARAT

483749

SUDIARTO (08121918055)

PER/18/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

10

01019

KLINIK MITRA SEHAT

JL. RAYA KOSAMBI CURUG NO 28 KARAWANG

433930

DR. YUNITA PUSPITASARI

PER/19/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

11

1500000000463

KLINIK NAYAKA

JL TUPAREV NO 334 B DAN C KARAWANG

418430

PENDI SUPENSI

PER/20/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

12

1500000000848

KLINIK PURWA MEDIKA

JL RAYA TAMELANG NO 53 DESA MEKARJAYA KEC. PURWASARI

433653

SUDIARTO (08121918055)

PER/21/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

13

1500000001948

KLINIK SATRIA MEKAR

JL PANGKALAN LOJI DESA TAMAN MEKAR KEC. PANGKALAN

085624943 888

YAYAT SALEH

PER/25/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

14

1500000000407

KLINIK YAKESTI

JL RAYA KLARI RT 01/02 GINTUNG KERTA KLARI KARAWANG

432416

MUHAMMAD SAFEI'I MA'ARIF

PER/22/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

15

1500000001714

KLINIK YASMIN

JL IR H JUANDA KM2 KOTA BARU RT 02/05

SAFRINA DEWI

PER/23/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

16

1500000000849

LIRA MEDIKA

JL SYECH QURO NO 14 PALUMBONSARI

8452555

NY ANGELIAQUE ARYANTO

PER/09/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

17

7-1272337870

RS BAYU KARTA

JL. KERTABUMI NO 44 KARAWANG

41311

026740181 8

DR WHISNU SANTOSO

PER/01/012016

RS.TRAUMA CENTRE

06/01/2016

31/12/2016

18

7-1122449393

RS CITO

JL. ARTERI TOL KARAWANG BARAT

41312

HAJI GANGGA ENDANG

PER/03/012016

RS.TRAUMA CENTRE

05/01/2016

31/12/2016

19

1400000000368

RS CITRA SARI HUSADA

JL RAYA KOSAMBI TELAGASARI KM 3 KLARI

ADE RELAWATI

PER/05/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

MA11222I

41311

41311

437507


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

20

1500000001708

RS DELIMA ASIH SISMA MEDIKA

JL WIRASABA NO 54 JOHAR KEC KARAWANG TIMUR

21

1400000000349

RS ISLAM KARAWANG

JL. PANGKAL PERJUANGAN KM. 2

22

1500000000408

RS IZZA

JL RAYA CISELANG DESA CIKAMPEK UTARA KECAMATAN KOTA BARU

23

1400000000348

RS KARYA HUSADA

JL. JEND. AHMAD YANI NO. 98 CIKAMPEK KARAWANG

24

1400000000347

RS PURI ASIH JATISARI

JL. RAYA JATISARI NO. 3 MEKARSARI JATISARI

25

7-2322882543

RS ROSELA

JL. INTERCHANGE NO 3 TOL KARAWANG BARAT DS WADAS

26

06823

RSU DELIMA ASIH SISMA MEDIKA

JL WIRASABA NO 54 JOHAR

27

7-1277095197

RUMAH SAKIT FIKRI MEDIKA

JL. RAYA KOSAMBI TELAGASARI KM 3

KANTOR CABANG

NO

1

KODE PROVIDER

1500000000232

MA11222I

:

KODE POS

41311

IKS TELEPON

PIMPINAN NO IKS

403073

8386830

41311

PT DELIMA SISMA MEDIKA

AWAL IKS

AKHIR IKS

PER/04/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

PER/06/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

PER/07/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

PER/08/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

DR AKID

PER/10/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

DR YESI KARYA LIANTI, MARS

PER/26/032015

RS.TRAUMA CENTRE

02/03/2016

31/12/2016

PER/04/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

PER/02/012015

RS.TRAUMA CENTRE

05/01/2016

30/06/2016

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

403073

41314

TIPE IKS

H SAEPUDIN

K11- KANTOR CABANG CIMAHI

NAMA PROVIDER

KLINIK NAYAKA ERA HUSADA

ALAMAT

JL. JEND. H. AMIR MACHMUD NO 477 CIBABAT CIMAHI

KODE POS

IKS TELEPON

PIMPINAN NO IKS

6640384

PT NAYAKA ERA HUSADA CABANG CIMAHI

PER/02/022016



AWAL IKS 22/04/2016


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

2

1500000000233

KLINIK PRATAMA SEHAT BUDI LUHUR

JL. KERKOF NO 32 CIMAHI SELATAN

6674146

KLINIK SEHAT BUDI LUHUR

PER/01/022016

RS.TRAUMA CENTRE

22/04/2016

28/02/2017

3

1500000000234

KLINIK WIJAYA MEDIKA

JL. RAYA CIBURUY NO 684 PADALARANG

6806125

KLINIK WIJAYA MEDIKA

PER/03/022016

RS.TRAUMA CENTRE

22/04/2016

28/02/2017

KANTOR CABANG

NO

KODE PROVIDER

:

K12- KANTOR CABANG SUMEDANG

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

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

2

1500000000482

KLINIK MEDIKA PRATAMA II

JL. RAYA BANDUNG GARUT NO.24 BOJONGLOA, RANCAEKEK

7537511

LULU FOTUANA

PER/15/032016

RS.TRAUMA CENTRE

11/05/2016

01/03/2017

3

1500000000483

KLINIK MEDIKA PRATAMA III

JL. RAYA BANJARAN NO.564, BOJONGMANGGU, PAMEUNGPEUK

7537511

LULU FOTUANA

PER/16/032016

RS.TRAUMA CENTRE

11/05/2016

01/03/2017

4

1500000000489

KLINIK NAYAKA HUSADA 05

JL. MOH. TOHA PALASARI , DAYEUH KOLOT

085106398 668

PT. NAYAKA ERA HUSADA

PER/11/032016

RS.TRAUMA CENTRE

11/05/2016

01/03/2017

5

1500000000488


JL. BALEKAMBANG SUKAMAJU MAJALAYA

082318663 334


PER/12/032016

RS.TRAUMA CENTRE

11/05/2016

01/03/2017

6

1500000000492

KLINIK RATNASARI SEHAT

JL. SOREANG BANJARAN, CILUNCAT, CANGKUANG

081206052 93

DR. RATNA SARIHARYANTI

PER/14/03/2016

RS.TRAUMA CENTRE

11/05/2016

01/03/2017

7

0900000000038

RS AMC (TRAUMA CENTRE)

JL. RAYA CILEUNYI RANCAEKEK

7781630

PT. ANISSA EKA UTAMA

PER/07/012016

RS.TRAUMA CENTRE

11/05/2016

01/01/2017

MA11222I


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NO

8

KODE PROVIDER

RSUD KABUPATEN SUMEDANG

1500000000505

KANTOR CABANG

NO

NAMA PROVIDER

KODE PROVIDER

:

ALAMAT

KODE POS

JL. P GEUSAN ULUN NO.41

IKS TELEPON

PIMPINAN NO IKS

7217744

PEMDA JAWA BARAT

PER/09/012016

TIPE IKS

AWAL IKS

RS.TRAUMA CENTRE

19/04/2016


K13- KANTOR CABANG TANGERANG CIKUPA

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000001507

KLINIK BHAKTI MULYA KRONJO

JL.RAYA KRONJO NO.6 DESA PASILIAN KRONJO

DR.A GHOFIR

PKS/31/122015

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

2

1500000001506

KLINIK BKKM BANTEN

JL RAYA SERANG KM.31 SUMUR BANDUNG JAYANTI

DR.H.A DRAJAT A.P MKES

PKS/33/122015

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

3

1500000001513

KLINIK CITRA INSANI

MARDI GRAS RUKO KF02/05 CITRA RAYA CIKUPA

DR SABRI

PKS/32/122015

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

4

1500000001314

KLINIK MILENIA SEJAHTERA 1 TIGARAKSA

JL MILENIUM RAYA 1A /A11 18-19 TIGARAKSA

29006869

PKS/28/122015

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

5

1500000001309

KLINIK MILENIA SEJAHTERA 2 BALARAJA

RUKO ULITMATE BLOK A1-2 JL RAYA SERANG KM24 BALARAJA

29015571

PKS/29/122015

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

6

1500000001512

KLINIK MULYA RAHAYU

JL. PLP LEGOK ASEM NO.124 LEGOK

HJ SRI LIS RAHAYU

PKS/30/122015

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

7

1500000001508

KLINIK PRIMA MEDIKA

JL. RAYA SERANG KM.14,8 KOMP RUKO B/16 CIKUPA

MUSAFAH

PKS/34/122015

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

8

1500000001510

KLINIK PRIMA SENTUL

JL. RAYA SERANG KM.24 A/11 SENTUL BALARAJA

MUSAFAH

PKS/35/122015

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

MA11222I


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NO

9

KODE PROVIDER

KLINIK UMUM & BERSALIN YULISATI

1500000001504

KANTOR CABANG

NO

NAMA PROVIDER

KODE PROVIDER

:

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

JL. RAYA SERANG KM 36 JAYANTI 10/03

DR. MAWARDI LUBIS

PKS/36/122015

TIPE IKS

AWAL IKS

RS.TRAUMA CENTRE

11/01/2016


K14- KANTOR CABANG BEKASI CIKARANG

NAMA PROVIDER

ALAMAT

1

1400000000549

KLINIK GRAHA BINA HUSADA

JL.INDUSTRI SELATAN NO.1A, BLOK NN3AJABABEKA II, CIKARANG BARU

2

7-1254255963

KLINIK KASIH ANUGERAH SERANG BARU

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

3

7-1251921754

RS AMANDA

4

7-1432249443

5

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

PT.GRAHA BINA HUSADA

PER/54/122015

RS.TRAUMA CENTRE

05/01/2016

30/11/2016

17530

DR KETTLER SIAHAAN, MBA

PER/58/122015

RS.TRAUMA CENTRE

04/01/2016

04/11/2016

JALAN RAYA SERANG , NO. 83 CIKARANG

17530

DR.HAMIDAH, M.KES

PER/60/122015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

RS ANNISA CIKARANG

JL 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

7-2767325803

RS APRILIA MEDIKA

DI JALAN RAYA SETU NO.99, DESA LUBANG BUAYA , KEC SETU, KAB. BEKASI,

17530

DR LENI ASTUTI , DR

PER/11/032016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

6

1400000000055

RS BHAKTI HUSADA

JL.R.E.MARTADINATA BY PASS CIKARANGBEKASI

PT HUSADA PURWAKARTA

PER/10/032016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

7

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

8

7-1250333673

RS HOSANA LIPPO CIKARANG

JL UTAMA BIIE ,NO. 01, LIPPO CIKARANG BEKASI

17530

JOHANNES POSO

PER/56/122015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

MA11222I

89836243

89110896


SM0480



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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

NO IKS

9

1500000000495

RS MEDIROSSA

JL INDUSTRI TEGAL GEDE NO.9, CIKARANG SELATAN

89833216

10

1300000000022

RS. PERMATA KELUARGA

JL.M.H. THAMRIN KAV 129 LIPPO CIKARANG

89905588

KANTOR CABANG

NO

KODE PROVIDER

:

PIMPINAN

PT MEDIROSSA MITRA INSANI

TIPE IKS

AWAL IKS

AKHIR IKS

PER / 07 /032016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

PER/08/032016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

K15- KANTOR CABANG BANDUNG LODAYA

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000873

KLINIK ALBAR

JL TERUSAN KOPO NO 371 KOPO MARGAHAYU

40225

085863333 599

YAYASAN LESTARI

PER/14/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

2

1400000000252

KLINIK AVIATI KOPO

JL KOPO NO. 59 PANJUNAN - KOTA BANDUNG

40241

5232291

PT. AVIATI PRIMA CITRA

PER/09/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

3

1500000001810

KLINIK BHAYANGKARA HUSADA POLRES BANDUNG

JL. BHAYANGKARA NO. 1 POLRES BANDUNG - SOREANG

40911

85871980

POLRES BANDUNG

PER/16/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

4

1500000001538

KLINIK INSANIYAH MEDICAL CENTRE

JL TERUSAN AL FATHU KM 17 RT 05 RW 04 DESA PAMEKARAN SOREANG

40911

85874343

PMI KAB BANDUNG

PER/17/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

5

1500000001541

KLINIK KATAPANG

JL TERUSAN KOPO NO 65 KATAPANGSOREANG

40921

21175677

DR.FELIX KASIM, M.KES

PER/18/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

6

1500000001537

KLINIK LUHUR MEDICA CENTRE

JL JEND SUDIRMAN NO 472/474 ANDIR BANDUNG

40182

6037679

CV LUHUR MEDICA CENTRE

PER/19/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

1400000000251


JL TERUSAN KOPO KM 12 KATAPANG KAB. BANDUNG

40921

61804614


PER/08/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

8

1500000000871

KLINIK NORMA MASITHA

JL RAYA TIMUR NO 41 BANJARAN KAB BANDUNG

40377

5944144

DR HJ ROSIDAH AGUS

PER/11/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

9

1500000000911

KLINIK RATNASARI 2

JL RAYA CIWIDEY KP PEER RT 03 RW 23 DESA CIWIDEY KEC CIWIDEY

40973

5927794

APENG HIDAYAT

PER/13/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

10

1500000000872

KLINIK SAHABAT SEHAT AMPUH

JL TERUSAN KOPO NO 593 KM 11,5 DS PANGAUBAN KATAPANG

40921

5897000

DRS AHMAD SUHANDA

PER/10/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

11

1500000000882

KLINIK SEHAT MEDIKA UTAMA

JL PANGALENGAN SITU CILEUNCA KP SIDAMUKTI RT 01 RW 04 PANGALENGAN

40378

081320605 293

APENG HIDAYAT

PER/12/2016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

12

1500000001330

KLINIK SEHAT SEJAHTERA

JL LAMAJANG NO.119 DAYEUHKOLOT

40238

5204139

DR RUKHIYAT SYAHIDIN

PER/07/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

13

1500000001709

KLINIK WIDYA BHAKTI INTI

JL. MOCH TOHA NO.77 BANDUNG

40253

5201501

PT.WIDYA BHAKTI INTI

PER/15/012016

RS.TRAUMA CENTRE

01/01/2016

31/01/2016

14

1400000000080

RSUD AL IHSAN PROV. JABAR

JL KIASTRAMANGGALA - BALEENDAH

40258

5940872

PEMDA PROVINSI JABAR

PER/02/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

15

1100000000025

RUMAH SAKIT IMMANUEL

JL. KOPO NO 161 KOTA BANDUNG

40241

5201051

YAYASAN BRS GK PASUNDAN

PER/01/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

16

1500000001540

RUMAH SAKIT UMUM DAERAH SOREANG

JL ALUN ALUN UTARA NO 1 SOREANG

40911

5891355

PEMERINTAH DAERAH KAB. BANDUNG

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

17

1500000001715

SANTOSA HOSPITAL BANDUNG CENTRAL

JL KEBONJATI NO 38 BANDUNG

40181

4248555

PT SANBE PRAKARSA HUSADA

PER/04/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

18

1500000001388

SANTOSA HOSPITAL BANDUNG KOPO

KH. WAHID HASYIM NO 461- 463 KOPO BANDUNG

40221

54280555

PT SANBE PRAKARSA HUSADA

PER/03/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

KANTOR CABANG

MA11222I

:

K16- KANTOR CABANG BOGOR CILEUNGSI


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000001174

KLINIK ANGGI

KP CIBEBER DS KAHURIPAN KLAPANUNGGAL

29219678

YAYASAN NOGI SEHATI

PER/04/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

2

1500000001514

KLINIK DERA ASSYIFA

JL RAYA NAROGONG KM 23 DESA CILEUNGSI

8234492

PT. DURASTIKA SOMA WIJAYA

PER/09/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

3

1500000001382

KLINIK DR IRMAN

PERUM GRIYA ALAM SENTOSA BLOK C9 NO 4 RT 10/08 PASIRANGIN CILEUNGSI

YAYASAN SUMARNO MEDIKA

PER/08/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

4

1500000001207

KLINIK DR. MARZUKI

JL RAYA CILEUNGSI JONGGOL KM 2,2

DR MARZUKI

PER/05/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

5

7-1552354085

KLINIK EDELWEISS

PERUMAHAN CITRA GRAND CIBUBUR RUKO CITYWALK 2 NO 1-2 JATI KARYA SAMPURNA BEKASI

16820

DR AFRIYANTI SANDHI

PER/12/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

6

1500000001690

KLINIK EKA MEDIKA

JL RAYA NAROGONG NO 116 KLAPANUNGGAL

16820

DR HARUMITI RAMIL,MKK

PER/11/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

7

1500000001687

KLINIK GRACIA

JL RAYA NAROGONG KM 17 DESA CILEUNGSI

16820

SURYATI SARI ARUM, SKOM

PER/10/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

8

1500000001331

KLINIK MH THAMRIN MEKARSARI

RUKO EBONY BLOK 23 RT 006/004 DESA CILEUNGSI

DR RISKA ARISKA YULIANTI

PER/06/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

9

1500000001383

KLINIK PKO MUHAMMADIYAH

PERUM PTSC JL ANGGREK BLOK A NO 12 KEC CILEUNGSI

DR NUR CAHYANINGSIH

PER/07/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

10

1500000001691

RS HERMINA MEKARSARI

JL RAYA CILEUNGSI JONGGOL KM 1

16820

29232525

VIVI FRIYATNI, SKM

PER/01/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

11

1500000001927

RS PERMATA JONGGOL

JL RAYA JONGGOL NO 1 A SUKAMANAH JONGGOL

16120

89931333

DR EVY FEBRINA NURPENI, MARS

PER/03/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

12

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

MA11222I

29289475

8235052


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NO

13

KODE PROVIDER

TC RSIA KENARI GRAHA MEDIKA

1500000000590

KANTOR CABANG

NO

NAMA PROVIDER

:

KODE PROVIDER

ALAMAT

KODE POS

GRIYA KENARI MAS BLOK B2 CILEUNGSI BOGOR

ALAMAT

KODE POS

7-3271915318

KLINIK GEBANG MEDIKA

JL PRABU KIAN SANTANG NO 30 RT 001 RW 001 KEL GEBANG RAYA KEC PERIUK KOTA TANGERANG

15131

2

1500000000649

RS DINDA

GALUH NO 2 JATIUWUNG

3

1500000000649

RS DINDA

GALUH NO 2 JATIUWUNG

4

1100000000004

RSU AN NISA

JL GATOT SUBROTO NO 96 KM 3, CIBODAS

5

1100000000005

RSU ARIYA MEDIKA

JL INDUSTRI RAYA I BLOK A NO.1-10 JATAKE

NO

1

KODE PROVIDER

1500000001929

MA11222I

DRA FATIMAH

PER/15/032016

TIPE IKS

AWAL IKS

RS.TRAUMA CENTRE

11/05/2016


K17- KANTOR CABANG TANGERANG CIMONE

NAMA PROVIDER

:

PIMPINAN NO IKS

8230426

1

KANTOR CABANG

IKS TELEPON

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

DRA PUJI WAHYUNI

PER / 09 / 042016

RS.TRAUMA CENTRE

10/05/2016

31/03/2017

15133

PT DINDA MEDISTRA

PER/04/042016

RS.TRAUMA CENTRE

26/01/2016

31/12/2016

15133

PT DINDA MEDISTRA

PER/04/012016

RS.TRAUMA CENTRE

26/01/2016

31/12/2016

5525564

DR EDIANSYAH, MARS

PER/05/2016

RS.TRAUMA CENTRE

27/01/2016

31/12/2016

5902226

DR E TRISNO SUSILO

PER/06/022016

RS.TRAUMA CENTRE

12/02/2016

31/01/2017

55773345

K18- KANTOR CABANG DEPOK

NAMA PROVIDER

KLINIK BHAKTI JAYA

ALAMAT

JL. KARTINI - CITAYAM RAYA NO.18 A

KODE POS

16411

IKS TELEPON

PIMPINAN NO IKS

77203062

DRG.SRI SULISWATI,MM

PER/32/122015



AWAL IKS 01/01/2016


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

2

1500000001808

KLINIK IRENK MEDIKA

JL BAHAGIA RAYA NO 18 DEPOK TIMUR

16413

7715039

ARUJI AMBAR SUKOCO, SE

PER/31/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

3

1500000001922

KLINIK YANI MEDIKA

JL KARTINI NO 48 RT.03/09 KEL DEPOK KEC PANCORAN MAS

16414

77219553

DR YANI HARYANI

PER/33/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

4

1500000001971

PRAKTEK DR MAS'UD

JL CINERE RAYA PERUMAHAN GRIYA CINERE 2 KAV 48 NO 12A LIMO

16421

7533780

DR. MAS'UD

PER/34/122015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

5

1400000000184

RS BHAKTI YUDHA

JL RAYA SAWANGAN NO 2A DEPOK

16511

7520082

THAMAS INVESTAMA GUNA

PER/27/122015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

6

1400000000183

RS BHAYANGKARA SIKESJAS KORBRIMOB

JL RAYA AKSES UI KELAPA DUA DEPOK

87704691

DR TAUFIK

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

1400000000528

RS CITRA MEDIKA DEPOK

JL.RAYA KALIMULYA NO.68 CILODONG KOTA KEMBANG DEPOK

29671000

DR NENCY

PER/28/122015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

8

7-2718973400

RS HERMINA DEPOK

JL RAYA SILIWANGI NO 50 PANCORAN MAS DEPOK

16431

77202525

PT MEDIKALOKA HUSADA

PER/08/032016

RS.TRAUMA CENTRE

04/04/2016

31/12/2016

9

1500000001916

RS PERMATA DEPOK

JL RAYA MUCHTAR NO.22 SAWANGAN DEPOK

16511

29669000

PT MUFIDAH MEDIKA SAWANGAN

PER/29/122015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

10

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

11

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

12

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

13

1400000000285

RSTC GRHA PERMATA IBU

JL KH USMAN NO 168 BEJI KUKUSAN DEPOK

7778899

DR PARAMITA

PER/25/122015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

MA11222I


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NO

:

KODE PROVIDER

K19- KANTOR CABANG TANGERANG BSD

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

DR MURTININGRUM

PER/04/042016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

DR. HJ. DIANA FACHRUDIN

PER/05/042016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

PER/06/042016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

DR AYAT RAHAYU SP.RAD. MKES

PER/07/042016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

CIPUTAT TIMUR

DR AYAT RAHAYU SP.RAD. M.KES

PER/08/042016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

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

1500000000443

KLINIK SURADITA

JL WIJAYA KUSUMA RAYA 10 - 11 PERUMNAS SURADITA

DR HJ SITI MURWANI

PER/10/042016

RS.TRAUMA CENTRE

01/04/2016

31/03/2017

8

7-1679975283

RS OMNI ALAM SUTERA

JL ALAM SUTERA BOULEVARD KAV 25 SERPONG

53125555

PT SARANA MEDITAMA INTERNATIONAL

PER/01/012016

RS.TRAUMA CENTRE

01/02/2016

31/01/2017

9

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

1

1500000000448

KLINIK AMIRA

GRIYA LOKA BSD TANGSEL

2

1500000000621

KLINIK DIANA PERMATA MEDIKA

JL MH. THAMRIN KAV. 888C PANUNGGANGAN PINANG

5397314

3

1500000000323

KLINIK DR RANNY

JL BUARAN RAYA RT 003/001 SERPONG

75874222

4

1500000000441

KLINIK MAKMUR JAYA

JL CEGER RAYA - PONDOK AREN

5

1500000000440

KLINIK MAKMUR JAYA I CIPUTAT

6

1500000000442

7

KANTOR CABANG

MA11222I

:

15325

L00- KANTOR CABANG SEMARANG PEMUDA


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

1

7-1435412603

PUSKESMAS BRATI

JL. RAYA KUDUS KRONGGEN PURWODADI NO. 20, KEC. BRATI

58153

2

7-1435686266

PUSKESMAS GABUS I

JL. TAMAN SARI DS. SULUSARI, KEC. GABUS

3

7-1435751247

PUSKESMAS GABUS II

4

7-1435773598

5

IKS TELEPON

PIMPINAN NO IKS

AWAL IKS

AKHIR IKS

MURSIYATI, SKM

PER/22-1/112015

RS.TRAUMA CENTRE

15/01/2016

31/12/2016

58183

SOEPARNO, SKM

PER/22-2/112015

RS.TRAUMA CENTRE

15/01/2016

31/12/2016

JL SADANG DS. KARANGREJO, KEC. GABUS

58183

TOTOK EKO SUBANDRIYO, SKM

PER/22-3/112015

RS.TRAUMA CENTRE

15/01/2016

31/12/2016

PUSKESMAS GEYER I

JL. RAYA SOLO PURWADADI, KEC. GEYER

58172

DR. AGUNG PROBO M, M.SI

PER/22-4/112015

RS.TRAUMA CENTRE

15/01/2016

31/12/2016

7-1435791349

PUSKESMAS GEYER II

DS. BANGSRI, KEC. GEYER

58172

EDI SUCIPTO, S.KEP.M.KES

PER/22-5/112015

RS.TRAUMA CENTRE

15/01/2016

31/12/2016

6

7-1444349893

PUSKESMAS GODONG I

JL. RAYA SEMARANG, KEC. GODONG

58162

DR. WIWIK WIBAWA

PER/22-6/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

7

7-1444478904

PUSKESMAS GODONG II

DS. SAMBUNG, KEC. GODONG

58162

DRG. SISWANTO HANANTA

PER/22-7/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

8

7-1444574355

PUSKESMAS GROBOGAN

JL. PUGER NO.160, KEC. GROBOGAN

58152

029277030 06

DR. AGUS BUDIYANTO

PER/22-8/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

9

7-1444762696

PUSKESMAS GUBUG I

JL. A. YANI 119, KEC. GUBUG

58164

029253332 6

DR. ARIEF GUNAWAN

PER/22-9/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

10

7-1444853077

PUSKESMAS GUBUG II

JL. RAYA PILANG JEKETRO KM. 7, KEC.GUBUG

58164

029251353 488

DR. SUWINDI

PER/2210/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

11

7-1444951638

PUSKESMAS KARANGRAYUNG I

JL. GONDONG JUWANGI, KEC. KARANGRAYUNG

58163

AGUNG DWI SUJATMOKO, SKM

PER/2211/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

12

7-1445380831

PUSKESMAS KARANGRAYUNG II

JL. RAYA TELAWAH, KEC. KARANGRAYUNG

58163

PUJIYONO, SKM,M.KES

PER/2212/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

MA11222I

085290455 655

TIPE IKS

00551107

029265932 2


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

13

7-1445437092

PUSKESMAS KEDUNGJATI

JL. RAYA KEDUNGJATI, KEC. KEDUNGJATI

58167

029265808 8

DR. HARDJOKO

PER/2213/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

14

7-1445504163

PUSKESMAS KLAMBU

DS. KLAMBU, KEC. KLAMBU

58154

081575586 160

SIGIT TYASMONO, SKM

PER/2214/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

15

7-1445537804

PUSKESMAS KRADENAN I

JL. SURYOJENGGOLO 16 KUWU, KEC. KRADENAN

58182

029276124 1

DR. YATINO

PER/2215/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

16

7-1445609485

PUSKESMAS KRADENAN II

JL. HONGGO KUSUMAN 13, KEC KRADENAN

58182

029276157 7

SUBANDI, SKM

PER/2216/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

17

7-1445738346

PUSKESMAS NGARINGAN

JL. RAYA BLORA, KEC. NGARINGAN

58193

081225177 040

M. ABDUL RAUF, S.KEP, M.KES

PER/2217/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

18

7-1445782077

PUSKESMAS PENAWANGAN I

JL. RAYA PURWODADI, KEC. PENAWANGAN

58161

029242710 70

DR. DIANA FAJAR UDHARITA

PER/2218/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

19

7-1445869188

PUSKESMAS PENAWANGAN II

JL. RAYA SEDADI KM 3, KEC. PENAWANGAN

58161

DR. AGUS BUDI SARJONO, MM

PER/2219/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

20

7-1445943179

PUSKESMAS PULOKULON I

JL. RAYA . PANUNGGALAN NO 137, KEC. PULOKULON

58181

RIJADI AZIKIN, SKM, M.KES

PER/2220/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

21

7-1445969030

PUSKESMAS PULOKULON II

JL. DAYANG KUWU NO.18, KEC. PULOKULON

58181

DR. PUNGKI ADHITAMA P

PER/2221/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

22

7-1446062441

PUSKESMAS PURWODADI I

JL. GAJAH MADA NO. 1, KEC. PURWODADI

58111

029242154 1

DR. RINI ARYANTI

PER/2222/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

23

7-1446286013

PUSKESMAS PURWODADI II

DS. NAMBUHAN, KEC PURWODADI

58111

029277014 14

DR. RINJANI SURYANINGSIH, MA

PER/2223/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

24

7-1446397684

PUSKESMAS TANGGUNGHARJO

DS. TANGGUNGHARJO NO. 12A, KEC. TANGGUNGHARJO

58166

DR. KUSAINI

PER/2224/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

MA11222I

081325129 862


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

NO IKS

25

7-1446533475

PUSKESMAS TAWANGHARJO

JL. RAYA PURWODADI BLORA POJOK, KEC. TAWANGHARJO

58191

26

7-1446647286

PUSKESMAS TEGOWANU

JL. GATOT SUBROTO NO. 128, KEC. TEGOWANU

58165

27

7-1446759157

PUSKESMAS TOROH I

JL. RAYA SOLO 171 DS. DEPOK, KEC. TOROH

58171

28

7-1446805408

PUSKESMAS TOROH II

DS. TUNGGAK, KEC.TOROH

58171

29

7-1446854619

PUSKESMAS WIROSARI I

JL. KUSUMA BANGSA, KEC. WIROSARI

58192

30

7-1446890010

PUSKESMAS WIROSARI II

JL TAMBAK NO. 1 DS. KARANG ASEM, KEC. WIROSARI

58192

31

1400000000218

RS BHAKTI WIRA TAMTAMA

JL DR SOETOMO NO 17

3555944

32

1500000000212

RS ISLAM KENDAL

JL AR RAHMAH NO 17 WELERI KENDAL

641870

33

1400000000217

RS PELITA ANUGERAH

JL RAYA BANDUNGREJO KM 11.5 MRANGGEN

34

1500000000210

RS PERMATA BUNDA

35

1400000000219

36

1500000000211

MA11222I

PIMPINAN TIPE IKS

AWAL IKS

AKHIR IKS

DRG. RENDRA M

PER/2225/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

029251351 50

DR. EKO TAKARIYANTO

PER/2226/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

029255219 2

AGUS SETIJORINI, SKM

PER/2227/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

DR. ENDAH YULI RATNAWATI

PER/2228/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

DJAKA WIDADA B, SKM

445/1722/2014

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

SUTRISNO, SKM

PER/2230/112015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

DRG EDI SUMARWANTO MM MH KES

PER/25/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

6725555

LIDIA MEGAWATI

PER/23/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

JL HAYAM WURUK NO 24 PURWODADI

422838

DR H UTOMO DS SPOG

PER/31/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

RS PERMATA MEDIKA

JL MOCH ICHSAN NO 93-97 NGALIYAN

7625005

PER/24/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

RSUD DR R SOEDJATI SOEMODIARDJO

JL DI PANJAITAN 36 PURWODADI

421004

PER/30/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

029276102 9

DR BAMBANG PUJIYANTO M.KES


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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

37

1400000000216

RSUD KOTA SEMARANG

JL FATMAWATI NO 1 SEMARANG

6711500

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

38

1400000000214

RSUD TUGUREJO

JL. RAYA TUGUREJO KM 9 TAMBAK AJI NGALIYAN

7605297

PER/27/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

KANTOR CABANG

NO

KODE PROVIDER

:

L01- KANTOR CABANG SURAKARTA

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000142

KLINIK GRIYA HUSADA 1

JL. MEKARSARI RT 03 RW 01 POPONGAN KARANGANYAR

6499639

DR HADIASRI WIDIYASARI

PER/14/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

2

1500000000143


SURUH KALONG PANDEYAN TASIKMADU RT 1/ RW 7 KARANGANYAR

9726555

DR ITA KUSUMAWATI

PER/16/012016

RS.TRAUMA CENTRE

15/03/2016

31/12/2016

3

1500000000144


JL SOLO PURWODADI KM 6 GONDANGREJO KARANGANYAR

29726555

CV GRIYA DAYA MANDIRI

PER/17/012016

RS.TRAUMA CENTRE

15/03/2016

31/12/2016

4

1500000001791

KLINIK NAYAKA HUSADA 07 KARANGANYAR

JL RAYA SOLO SRAGEN KM 10 DAWUNG RT 02/01 DESA KEMIRI KEBAKKRAMAT


PER/29/012016

RS.TRAUMA CENTRE

29/01/2016

31/12/2016

5

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

6

1400000000516

KLINIK NGUDI SEHAT

JL. TENTARA PELAJAR NO. 31 SANGGRAHAN GROGOL SUKOHARJO

2974269

SUHADI

PER/18/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

7

1500000000106

KLINIK NGUDI SEHAT PARANGJORO

SINGKIL RT 03 RW 08 PARANGJORO GROGOL SUKOHARJO

2974269

KLINIK NGUDI SEHAT PARANGJORO

PER/10/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

MA11222I

57171


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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

8

1500000000417

KLINIK NURIFA

JL SLAMET RIYADI KARTASURA SUKOHARJO ( KIOS PASAR BUMI REJO )

9

7-2885229574

KLINIK PRATAMA IIS MEDIKA

JL SLAMET RIYADI 156 KARTASURA SUKOHARJO

10

7-2883966473

KLINIK PRATAMA SARI SEHAT

11

7-3073245233

12

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

2601843

DR UMI ARIFAH

PER/22/012016

RS.TRAUMA CENTRE

29/01/2016

31/12/2016

57161

081287929 00

CV CHAFAZKA INSAN MULIA

PER/43/042016

RS.TRAUMA CENTRE

13/04/2016

31/12/2018

JATI RT 03/02 JATEN KARANGANYAR

57731

91021574

DR SRI HARTINI

[PER/41/042016

RS.TRAUMA CENTRE

13/04/2016

31/12/2018

KLINIK TEDUH

JL. SUWARNO HONGGOPATI JLOGO GEDANGAN GROGOL SUKOHARJO

57552

666599812 556

YAYASAN PANTI KOSALA

PER/45/042016

RS.TRAUMA CENTRE

02/05/2016

31/12/2018

1100000000030

PUSKESMAS KEBAKKRAMAT

JL RAYA SOLO- SRAGEN KM 12

825812

PER/01/012016

RS.TRAUMA CENTRE

15/03/2016

31/12/2016

13

1400000000474

RS DR OEN SOLO BARU

PERUMAHAN SOLO BARU GROGOL

620220

RS DR OEN SOLO BARU

PER/07/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

14

1100000000033

RS DR OEN SURAKARTA

JL. BRIGJEND KATAMSO 55

643139

YYS PANTI KOSALA

PER/12/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

15

1500000001866

RS HERMINA SOLO

JL KOL SUTARTO NO. 16 RT 01/02 JEBRES SURAKARTA

638989

PT MEDIKA LOKA SOLO

PER/30/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

16

1100000000034

RS KASIH IBU SURAKARTA

JL SLAMET RIYADI 404

714422

YYS KASIH IBU

PER/08/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

17

1500000001873

RS KHUSUS BEDAH KARIMA UTAMA SURAKARTA

JL. AMARTA RAYA 8-10 TERMINAL BARU NGABEYAN KARTASURA

783399

PT. KARIMA UTAMA SEJAHTERA

PER/32/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

18

1100000000032

RS KUSTATI

JL KAPT MULYADI 249

643013

PER/09/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

19

1500000001009

RS LANUD ADI SOEMARMO

JL TENTARA PELAJAR MALANGJIWAN COLOMADU

780240

PER/26/012016

RS.TRAUMA CENTRE

15/03/2016

31/12/2016

MA11222I

57116

TNI AU SURAKARTA


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

20

7-2461866504

RS MEDIKA MULYA WONOGIRI

JL WONOGIRI - NGADIROJO KM 5 WONOGIRI

57652

YAYASAN RS MEDIKA MULYA

PER/37/032016

RS.TRAUMA CENTRE

15/03/2016

31/12/2016

21

7-2875438383

RS MULIA HATI WONOGIRI

JL RM SAID BRUMBUNG KALIANCAR SELOGIRI

57652

PT MULIA SURGICA WONOGIRI

PER/40/032016

RS.TRAUMA CENTRE

13/04/2016

31/12/2016

22

1400000000536

RS NIRMALA SURI SUKOHARJO

JL SOLO SUKOHARJO KM 9

RS NIRMALA SURI SUKOHARJO

PER/19/012016

RS.TRAUMA CENTRE

15/01/2016

31/12/2016

23

1100000000035

RS ORTHOPEDI PROF DR SOEHARSO

JL. JEND A YANI PABELAN

714458

PER/02/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

24

1100000000031

RS PANTI WALUYO

JL A YANI 1-2

712077

PER/15/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

25

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

26

1400000000537

RS PKU MUHAMADIYAH SURAKARTA

JL RONGGOWARSITO NO 130 SURAKARTA

714578


PER/20/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

27

1500000001946

RS PKU MUHAMMADIYAH KARANGANYAR

JL PAPAHAN DESA PAPAHAN KECAMATAN TASIKMADU

492685

YAYASAN MUHAMADIYAH

PER/31/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

28

1500000001628

RS PKU MUHAMMADIYAH SRAGEN

JL RAYA SOLO SRAGEN KM 8 MASARAN SRAGEN

YAYASAN MUHAMADIYAH

PER/28/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

29

08237

RS PKU MUHAMMADIYAH SURAKARTA

JL RONGGOWARSITO SURAKARTA


PER/20/012016

RS.TRAUMA CENTRE

29/01/2016

31/12/2016

30

1500000001531

RSI AMAL SEHAT SRAGEN

JL VETERAN NO 35 SRAGEN

YAYASAN AMAL SEHAT SRAGEN

PER/25/012016

RS.TRAUMA CENTRE

15/01/2016

31/12/2016

31

7-1689398627

RSO PROF DR R SOEHARSO SURAKARTA

JL A AYANI KARTASURA

KEMENKES

PER/02/012016

RS.TRAUMA CENTRE

29/01/2016

31/12/2016

MA11222I

57171

714578

50771

71445832


SM0480



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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

32

7-2888512933

RSU INDO SEHAT

JL. RAYA SOLO SRAGEN KM 11 KEBAKKRAMAT

33

1500000000121

RSU JATI HUSADA KARANGANYAR

34

1500000000687

35

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

YAYASAN INDO SEHAT

PER/42/042016

RS.TRAUMA CENTRE

13/04/2016

31/12/2018

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

RSU MARDI LESTARI

JL ROKAN NO 8 SRAGEN

YYS SANTA KATARINA L

PER/27/042015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

1500000000687

RSU MARDI LESTARI

JL ROKAN NO 8 SRAGEN

YYS SANTA KATARINA L

PER/24/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

36

1100000000036

RSUD DR MOEWARDI SURAKARTA

JL KOL SUTARTO 132

PER/03/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

37

7-3265778097

RSUD DR SOEDIRAN MANGUN SUMARSO KABUPATEN WONOGIRI

JL A YANI NO 40 WONOGIRI

PER/34/012016

RS.TRAUMA CENTRE

10/05/2016

31/12/2016

38

1500000000120

RSUD DR SOEHADI PRIJONEGORO SRAGEN

JL RAYA SUKOWATI 534 SRAGEN

PER/13/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

39

1400000000424

RSUD KABUPATEN KARANGANYAR

JL. LAKSDA YOS SUDARSO

495673

RSUD KABUPATEN KARANGANYAR

PER/04/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

40

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

41

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

42

7-2461234733

RUMAH SAKIT BRAYAT MINULYA

JL SETIA BUDI 106

57139

716646246 32

YAYASAN RS BRAYAT MINULYA

PER/36/032016

RS.TRAUMA CENTRE

15/03/2016

31/12/2016

43

7-3070677308

RUMAH SAKIT JIWA DAERAH SURAKARTA

JL KH DEWANTORO NO. 80 JEBRES SURAKARTA

57121

PEMERINTAH PROPINSI JATENG

PER/44/042016

RS.TRAUMA CENTRE

02/05/2016

31/12/2018

MA11222I

57762

634634

57611

PEMKAB WONOGIRI


SM0480



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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

44

7-2610514586

RUMAH SAKIT MARGA HUSADA

JL LETJEND S PARMAN WONOGIRI

57652

32194455

RS MARGA HUSADA WONOGIRI

PER/39/032016

RS.TRAUMA CENTRE

28/03/2016

31/12/2016

45

7-2519970682

RUMAH SAKIT SARILA HUSADA

JL VETERAN NO. 41-43 SRAGEN

57211

89119400

PT SARILA HUSADA

PER/23/012016

RS.TRAUMA CENTRE

15/03/2016

31/12/2016

46

7-2510145183

RUMAH SAKIT UMUM ISLAM YAKSSI GEMOLONG

JL SOLO PURWODADI KM 20

57274

YAYASAN YAKSSI GEMOLONG

PER/38/022016

RS.TRAUMA CENTRE

15/03/2016

31/12/2016

KANTOR CABANG

NO

:

KODE PROVIDER

L02- KANTOR CABANG CILACAP

NAMA PROVIDER

ALAMAT

1

7-2832594183

KLINIK HAMADA

JL. KENDENG NO. 43 RT 001 RW 004 DESA KURIPAN KEC KESUGIHAN KAB CILACAP

2

1500000000550

KLINIK NAYAKA HUSADA

JL. KOMPENI NO. 25 PIPA TIMUR

3

1400000000491

RS PKU MUHAMMADIYAH GOMBONG

4

1500000000431

5

1100000000021

KANTOR CABANG

MA11222I

:

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

EKO PRIYO ATMOJO, S.KEP.NS

PER/03/042016

RS.TRAUMA CENTRE

07/04/2016

31/12/2017

532149


PER/05/042016

RS.TRAUMA CENTRE

19/04/2016

31/12/2017

JL. YOS SUDARSO NO. 461 GOMBONG

471780

DR. IBNU NASER A, S. AG, MMR

PER/02/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

RSU SANTA MARIA CILACAP

JL. JEND. A. YANI NO. 38 KEL. SIDAKAYA KEC. CILACAP SELATAN

521725

YAYASAN MEDIATRIX

PER/04/042016

RS.TRAUMA CENTRE

19/04/2016

31/12/2017

RSUD CILACAP

JL GATOT SUBROTO NO. 28

533010

DR. NONO RASINO, SP.OG (K)

PER/01/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

53274

L03- KANTOR CABANG YOGYAKARTA


SM0480



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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000727

BLKPP DI YOGYAKARTA

JLN KYAI MOJO NO. 5 YOGYAKARTA

512619

DISNAKERTRANS DIY

PER/12/042016

RS.TRAUMA CENTRE

11/04/2016

28/02/2018

2

1500000000400

BP PMI DI YOGYAKARTA

JLN RING ROAD BARAT NO. 3, PATHUK, GAMPING, SLEMAN

6499652

PMI PROP DI YOGYAKARTA

PER/03/012016

RS.TRAUMA CENTRE

01/03/2016

28/02/2017

3

1500000000173

BP RB CITRA PARAMEDIKA

GRAULAN RT 06 RW 03 GIRIPENI WATES

774876

YAYASAN BINANGUN CITRA PARA MEDIKA

PER/10/042016

RS.TRAUMA CENTRE

11/04/2016

31/01/2018

4

1500000001289

KLINIK CHANDRA BRATA MEDIKA PLAZA

TAMBAKAN RT 002 RW 019 SINDUHARJO NGAGLIK

882702

ANDRA BRATA MEDIKA PLAZA

PER/44/052016

RS.TRAUMA CENTRE

01/06/2016

31/05/2018

5

1500000001334

KLINIK HARMONY

GENDENG GK IV/969, BACIRO

DR. ERNA

PER/45/052016

RS.TRAUMA CENTRE

01/06/2016

31/05/2018

6

1500000001238

KLINIK HIPERKES DAN KESELAMATAN KERJA

JLN. IREDA NO.38, KEPARAKAN, MERGANGSAN

BALAI HIPERKES

PER/21/052016

RS.TRAUMA CENTRE

09/05/2016

31/05/2018

7

1500000001284

KLINIK LARAS HATI

PRANCAK, GLONDONG, PANGGUNGHARJO, SEWON, BANTUL

RB LARAS HATI

PER/46/052016

RS.TRAUMA CENTRE

01/06/2016

31/05/2018

8

1500000001285

KLINIK LARAS HATI KULON PROGO

WONOLOPO RT 33 RW 15, GULUREJO, LENDAH

YAYASAN BHAKTI SOSIAL

PER/47/052016

RS.TRAUMA CENTRE

01/06/2016

31/05/2018

9

1500000001160

KLINIK PATALAN

JLN. PARANG TRITIS KM 15, PATALAN, JETIS

DR GLORY

PER/37/052016

RS.TRAUMA CENTRE

29/05/2016

30/04/2018

10

1500000000598

KLINIK PRATAMA ANUGERAH

JLN RINDANG NO. 145, JADAN, TAMANTIRTO, KASIHAN

DR. AR ROYAN

PER/16/042016

RS.TRAUMA CENTRE

11/04/2016

31/03/2018

11

1500000001237

KLINIK PRATAMA KARTIKA HUSADA

TEGALREJO NGLEGIS RT 05. SITIMULYO, BANTUL

PER/38/052016

RS.TRAUMA CENTRE

01/06/2016

31/05/2018

12

1500000000048

KLINIK PRATAMA MITRA SEHAT

JL IMOGIRI TIMUR KM 6 DLADAN BARU NGLEBENG TAMANAN BANGUNTAPAN

PER/50/122015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

MA11222I

55663

789670

9103190

CV MITRA SEHAT


SM0480



86 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

13

1500000000062

KLINIK PRATAMA SWA

JL SALAK/TURI KM 4 KADISOBO II RT 02 RW 03 TRIMULYO

7485660

YAYASAN SWA YOGYAKARTA

PER/51/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

14

1500000000063

KLINIK PRATAMA WIDURI

JL MAGELANG KM 12 WIDORO TRIHARJO SLEMAN

867363

CV WIDURI

PER/53/122015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

15

1500000001669

KLINIK UTAMA BEDAH ADELIA

DONOLOYO IA KROBOKAN TAMANAN BANGUNTAPAN

4396680

TRIYONO

PER/43/052016

RS.TRAUMA CENTRE

01/06/2016

31/05/2018

16

1500000001037

PUSKESMAS BAMBANGLIPURO

DAWETAN, SIDOMULYO, BAMBANGLIPURO

DINKES BANTUL

PER/23/082016

RS.TRAUMA CENTRE

28/05/2016

30/04/2018

17

1500000000399

PUSKESMAS BANGUNTAPAN II

KROBOKAN DESA TAMANAN, BANGUNTAPAN , BANTUL

DINKES KAB BANTUL

PER/10/042015

RS.TRAUMA CENTRE

11/04/2016

28/02/2018

18

1500000001042

PUSKESMAS DLINGO I

KORIPAN, DLINGO, BANTUL

DINKES BANTUL

PER/24/052016

RS.TRAUMA CENTRE

28/05/2016

30/04/2018

19

1500000001038

PUSKESMAS IMOGIRI I

NGANCAR, KARANGTALUN, IMOGIRI, BANTUL

DINKES BANTUL

PER/25/052016

RS.TRAUMA CENTRE

28/05/2016

30/04/2018

20

1500000001067

PUSKESMAS JETIS I

TELAN TRIMULY, JETIS BANTUL

DINKES BANTUL

PER/26/052016

RS.TRAUMA CENTRE

28/05/2016

30/04/2018

21

1500000001064

PUSKESMAS KASIHAN I

NGENTAK, BANGUNJIWO, KASIHAAN

DINKES BANTUL

PER/27/052016

RS.TRAUMA CENTRE

28/05/2016

30/04/2018

22

1500000000802

PUSKESMAS KRETEK

JL PARANGTRITIS KM 21, SRUWUH, DONOTIRTO, KRETEK

DINKES KAB BANTUL

PER/28/052016

RS.TRAUMA CENTRE

09/05/2016

30/04/2018

23

1500000001049

PUSKESMAS PAJANGAN

BEJI, SENDANGSARI, PAJANGAN, BANTUL

DINKES BANTUL

PER/29/052016

RS.TRAUMA CENTRE

28/05/2016

30/04/2018

24

1500000001063

PUSKESMAS PANDAK I

GESIKAN, WIJIREJO, PANDAK

DINKES BANTUL

PER/30/052016

RS.TRAUMA CENTRE

28/05/2016

30/04/2018

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

25

1500000001041

PUSKESMAS PIYUNGAN

PAYAK, SRIMULYO, PIYUNGAN

DINKES BANTUL

PER/22/072016

RS.TRAUMA CENTRE

28/05/2016

30/04/2018

26

1500000001047

PUSKESMAS PLERET

WONOKROMO, PLERET, BANTUL

DINKES BANTUL

PER/31/052016

RS.TRAUMA CENTRE

28/05/2016

30/04/2018

27

1500000001039

PUSKESMAS PUNDONG

PIRING, SRIHARDONO, PUNDONG, BANTUL

DINKES BANTUL

PER/32/052016

RS.TRAUMA CENTRE

28/05/2016

30/04/2018

28

1500000001048

PUSKESMAS SANDEN

PUCANGANOM, MURTIGADING, SANDEN

DINKES BANTUL

PER/33/052016

RS.TRAUMA CENTRE

28/05/2016

30/04/2018

29

1500000001066

PUSKESMAS SEDAYU I

KEMUSUK, ARGOMULYO, SEDAYU

DINKES BANTUL

PER/34/052016

RS.TRAUMA CENTRE

28/05/2016

30/04/2018

30

1500000000803

PUSKESMAS SEWON I

JLN. PARANGTRITIS KM 7, BANGI, TIMBULHARJO, SEWON

DINKES BANTUL

PER/35/052016

RS.TRAUMA CENTRE

09/05/2016

30/04/2018

31

1500000000804

PUSKESMAS SRANDAKAN

JL. RAYA SRANDAKAN, TRIMURTI, SRANDAKAN

DINKES BANTUL

PER/36/052016

RS.TRAUMA CENTRE

09/05/2016

30/04/2018

32

1400000000143

RS CONDONG CATUR

JL MANGGIS NO 6 GEMPOL CONDONG CATUR

887494

DR HERTI ELIZA SILALAHI

PER/17/052016

RS.TRAUMA CENTRE

01/06/2016

31/05/2018

33

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

34

1400000000142

RS PANTI NUGROHO

JL KALIURANG KM 17

895186

YAYASAN PANTI RAPIH

PER/14/042016

RS.TRAUMA CENTRE

11/04/2016

31/03/2018

35

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

36

1400000000005

RS PKU MUHAMMADIYAH BANTUL

JL. JEND SUDIRMAN NO.124

368238

YAYASAN MUHAMMADIYAH

PER/45/122015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

37

1400000000312

RS PKU MUHAMMADIYAH YOGYAKARTA

JL KHA DAHLAN 20

512653

38

1400000000136

RS QUEEN LATIFA

JL RING ROAD BARAT MLANGI NOGOTIRTO GAMPING

581402

39

1400000000139

RS RAJAWALI CITRA

JL.PLERET KM 2,5 BANJARDADAP POTORONO BANGUNTAPAN BANTUL

7482003

40

1500000001287

RSKIA PKU MUHAMMADIYAH KOTAGEDE

41

1500000001033

42

AWAL IKS

AKHIR IKS

PER/18/052016

RS.TRAUMA CENTRE

09/05/2016

30/04/2018

PER/48/122015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

DR H SUNU PRASMONO

PER/19/042016

RS.TRAUMA CENTRE

12/05/2016

30/04/2018

JLN KEMASAN NO.43, PURBAYAN, KOTAGEDE

MUHAMMADIYAH

PER/39/052016

RS.TRAUMA CENTRE

01/06/2016

31/05/2018

RSU AT-TUROST AL-ISLAMY

JLN. KLACI I, MARGOLUWIH, SEYEGAN

YAYASAN MAJELIS ATTUROST AL-ISLAMY

PER/40/052016

RS.TRAUMA CENTRE

09/05/2016

30/04/2018

1400000000478

RSU BHAYANGKARA POLDA DI YOGYAKARTA

JL JOGYA-SOLO KM 14 GLONDONG TIRTOMARTANI KALASAN

498278

POLDA DI YOGYAKARTA

PER/44/122015

RS.TRAUMA CENTRE

18/01/2016

30/11/2016

43

1500000000812

RSU GRIYA MAHARDIKA YOGYAKARTA

JLN. PARANGTRITIS KM 4,5 GG. WIJAYAKUSUMA NO. 212, SEWON

445020

PT. RSGM

PER/41/052016

RS.TRAUMA CENTRE

18/05/2016

30/04/2018

44

1400000000138

RSU KAB SLEMAN

JL BHAYANGKARA 48 MORANGAN SLEMAN

868437

PEMKAB BANTUL

PER/13/042016

RS.TRAUMA CENTRE

11/04/2016

31/03/2018

45

1500000000168

RSU KHARISMA PARAMEDIKA

JL KHUDORI NO. 34 WATES

774633

YAYASAN BINANGUN KHARISMA PARAMEDIKA

PER/09/042016

RS.TRAUMA CENTRE

11/04/2016

31/01/2018

46

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

47

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

48

1500000000858

RSU RACHMA HUSADA

JLN PARANG TRITIS KM 16, PATALAN, JETIS, BANTUL

YAYASAN BINA MITRA HUSADA

PER/42/052016

RS.TRAUMA CENTRE

09/05/2016

30/04/2018

MA11222I


TIPE IKS


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

49

1500000000327

RSUD KOTA YOGYAKARTA

JL WIROSABAN NO.1 YOGYAKARTA

371195

PEMKOT YOGYAKARTA

PER/01/012016

RS.TRAUMA CENTRE

01/02/2016

31/01/2017

50

1400000000475

RSUD WATES

JL TENTARA PELAJAR KM 1 NO 5

773169

PEMDA KULON PROGO

PER/43/122015

RS.TRAUMA CENTRE

18/01/2016

31/10/2016

51

1500000000586

RSUP DR SARDJITO

JLN KESEHATAN NO. 1, SEKIP, SINDUADI

587333

KEMENKES

PER/06/042016

RS.TRAUMA CENTRE

04/04/2016

31/03/2017

52

1400000000479

RUMAH 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

53

1400000000315

RUMAH SAKIT ISLAM YOGYAKARTA PDHI

JL SOLO KM 12,5 KALASAN SLEMAN

498000

PROF.DR.DR.H LAMSUDIN

PER/47/122015

RS.TRAUMA CENTRE

11/04/2016

31/12/2016

54

1400000000480

RUMAH SAKIT LUDIRA HUSADA TAMA

JL WIRATAMA NO. 4 TEGALREJO

620333

DR BONDAN AGUS SURYANTO

PER/46/122015

RS.TRAUMA CENTRE

18/01/2016

30/11/2016

55

1400000000695

RUMAH SAKIT NUR ROHMAH

JL WONOSARI-YOGYA KM 7 BANDUNG PLAYEN

394574

PT.RAHMA BAKTI HUSADA

PER/54/122015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

56

1400000000696

RUMAH SAKIT PANTI RAHAYU

JALAN WONOSARI-PONJONG KM 7 KELOR KARANGMOJO

392718

YAYASAN PANTI RAPIH

PER/52/122015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

57

1400000000134

RUMAH SAKIT PANTI RAPIH

JALAN CIK DI TIRO NO 30

514014

YAYASAN PANTI RAPIH

PER/20/052016

RS.TRAUMA CENTRE

09/06/2016

31/05/2018

KANTOR CABANG

MA11222I

:

L04- KANTOR CABANG PEKALONGAN


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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1400000000411

RS QOLBU INSAN MULIA (QIM)

JL URIP SUMOHARJO - SAMBONG

51211

4495222

PT QOLBU INSAN MULIA

PER / 24 /112015

RS.TRAUMA CENTRE

25/02/2016

31/10/2016

2

1400000000411

RS QOLBU INSAN MULIA (QIM)

JL URIP SUMOHARJO - SAMBONG

51211

4495222

PT QOLBU INSAN MULIA

PER / 24 /112015

RS.TRAUMA CENTRE

24/02/2016

31/10/2016

3

1500000000214

RSI PKU MUHAMMADIYAH PEKAJANGAN

JL RAYA AMBOKEMBANG NO 42-43 KEDUNGWUNI

51173

785133


PER / 002 / 022016

RS.TRAUMA CENTRE

02/03/2016

31/12/2017

KANTOR CABANG

NO

KODE PROVIDER

:

L05- KANTOR CABANG KUDUS

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000942

KLINIK PRATAMA ANUGERAH HEXA

JL JEPARA KM 3 TERSONO GARUNG LOR KALIWUNGU

DR ANWAR RIYANTO

PER/07/042016

RS.TRAUMA CENTRE

13/04/2016

31/12/2017

2

1500000000942

KLINIK PRATAMA ANUGERAH HEXA

JL JEPARA KM 3 TERSONO GARUNG LOR KALIWUNGU

DR ANWAR RIYANTO

PER/11/042016

RS.TRAUMA CENTRE

14/04/2016

31/12/2017

3

7-1073301393

KLINIK PRATAMA SEJAHTERA

JL RA KARTINI NO 15 PATI

DR JOKO MARDIYANTO

PER.030/X/2015

RS.TRAUMA CENTRE

07/01/2016

30/09/2016

4

1500000000641

POLIKLINIK YASMIN MEDIKA

JL SOEKARNO HATTA KM 4.8 RT 7/8 TAHUNAN

727047406

DINY NOOR KHAYATI

PER/04/042016

RS.TRAUMA CENTRE

13/04/2016

31/12/2017

5

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

6

1500000000661

RS PERMATA

JL REKSODIPURO NO 57

531624

PER/05/042016

RS.TRAUMA CENTRE

13/04/2016

31/12/2017

MA11222I

59111


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91 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

PER/08/042016

RS.TRAUMA CENTRE

14/04/2016

31/12/2017

RSI ARAFAH REMBANG

PER/07/042016

RS.TRAUMA CENTRE

14/04/2016

31/12/2017

RSI ARAFAH REMBANG

PER/03/042016

RS.TRAUMA CENTRE

13/04/2016

31/12/2017

JL RAYA PATI TAYU KM 18 DS WATUROYO MARGOYOSO

YKM NU

PER/06/042016

RS.TRAUMA CENTRE

14/04/2016

31/12/2017

RSI ISLAM PATI

JL RAYA PATI TAYU KM 18 DS WATUROYO MARGOYOSO

YKM NU

PER/06/042016

RS.TRAUMA CENTRE

13/04/2016

31/12/2017

1500000000138

RSI SULTAN HADLIRIN JEPARA

JL RAYA JEPARA BANGSRI KM 3 DS KUWASEN

591507

RSI SULTAN HADLIRIN JEPARA

PER/003/012016

RS.TRAUMA CENTRE

02/02/2016

31/12/2017

13

05896

RSK MARDI RAHAYU

JL AKBP R AGIL KUSUMADYA NO 110 KUDUS

434707

YAYASAN KRISTEN KESEJAHTERAAN MARDI RAHAYU

1482/DIR/PKS/I/ 2016

RS.TRAUMA CENTRE

19/01/2016

01/12/2016

14

05896

RSK MARDI RAHAYU

JL AKBP R AGIL KUSUMADYA NO 110 KUDUS

434707

YAYASAN KRISTEN KESEJAHTERAAN MARDI RAHAYU

PER/001/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

15

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

16

7-1061786476

RSUD DR LOEKMONO HADI KUDUS

JL DR LOEKMONO HADI NO 19 KUDUS

59319

029144400 1

PEMERINTAH DAERAH

440/327/23.01.01 /2015

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

17

7-1511265053

RSUD KELET

JL RAYA KELET KM 33 JEPARA

59454

DR WIDYO KUNTO M KES MRS

910/1448.B/X/20 15

RS.TRAUMA CENTRE

20/01/2016

31/10/2017

18

1400000000558

RSUD RA KARTINI KABUPATEN JEPARA

JL. WACHID HASYIM NO.100

RSUD JEPARA

PER/004/022016

RS.TRAUMA CENTRE

22/02/2016

31/12/2016

7

1500000000661

RS PERMATA

JL REKSODIPURO NO 57

531624

8

1500000000335

RSI ARAFAH REMBANG

JL RAYA REMBANG LASEM KM5 TRITUNGGAL

531666

9

1500000000335

RSI ARAFAH REMBANG

JL RAYA REMBANG LASEM KM5 TRITUNGGAL

531666

10

1500000000642

RSI ISLAM PATI

11

1500000000642

12

MA11222I

591175


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92 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

AWAL IKS

AKHIR IKS

26/01/2016

31/12/2016

295386111

SWASTA

8784/KSH/PKS/ XI/2015

RS.TRAUMA CENTRE

12/01/2016

01/09/2017

4245551

RUMAH SAKIT KUMALASIWI KUDUS

PER/005/2016

RS.TRAUMA CENTRE

02/02/2016

31/12/2017

59346

DR KHRISNA NUGRAHA W

PER/001/012016

RS.TRAUMA CENTRE

21/01/2016

31/12/2016

59431

DR WIDYO KUNTO M.KES MRS

PER/0035/11201 5

RS.TRAUMA CENTRE

21/01/2016

31/12/2016

JL.DR. SUSANTO NO. 114 PATI

59163

20

7-1061786478

RUMAH SAKIT KELUARGA SEHAT

JL P SUDIRMAN NO 9 MARGOREJO PATI

59163

21

1500000000137

RUMAH SAKIT KUMALASIWI KUDUS

JL JEPARA KM 6 DESA MIJEN RT 10 RW 06 KALIWUNGU

22

7-1534312103

RUMAH SAKIT MARDI RAHAYU KUDUS

JL AKBP R AGIL KUSUMADYA KUDUS

23

7-1534989054

RUMAH SAKIT UMUM DAERAH KELET

JL RAYA KELET KM 33 JEPARA

KODE PROVIDER


RSUD RAA SOEWONDO PATI

NO

NO IKS PER/009/012016

7-1601479543

:

PIMPINAN

DR. SUWORO NURCAHYONO.M.KES

19

KANTOR CABANG

IKS TELEPON

L06- KANTOR CABANG MAGELANG

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000112

RS PKU MUHAMMADIYAH TEMANGGUNG

JALAN RAYA KEDU KM 2 KALISAT CAMPURSARI BULU TEMANGGUNG

596704

PIMPINAN DAERAH MUHAMMADIYAH TEMANGGUNG

PER/04/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2017

2

1400000000467

RSU PKU MUHAMMADIYAH PURWOREJO

JL BRIGJEN KATAMSO NO 144A RT 1 RW 5 PANGENREJO PURWOREJO

325260

YAYASAN RSU PKU MUHAMMADIYAH

PER/18/112014

RS.TRAUMA CENTRE

13/04/2016

31/12/2015

3

1400000000467

RSU PKU MUHAMMADIYAH PURWOREJO

JL BRIGJEN KATAMSO NO 144A RT 1 RW 5 PANGENREJO PURWOREJO

325260

YAYASAN RSU PKU MUHAMMADIYAH

PER/03/012016

RS.TRAUMA CENTRE

13/04/2016

31/12/2017

4

7-1712506763

RSUD DR TJITROWARDOJO PURWOREJO

JL. JENDERAL SUDIRMAN NO. 60 PURWOREJO

275321118

RSUD DR TJITROWARDOJO PURWOREJO

PER/01/012016

RS.TRAUMA CENTRE

29/01/2016

31/12/2017

MA11222I

54114


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93 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

5

1500000000113

RUMAH SAKIT ISLAM WONOSOBO

JL MAYJEN BAMBANG SUGENG KM 03 MENDOLO BUMIRESO

322961

YAYASAN AMAL DAN KESEJAHTERAAN UMAT ISLAM (YAKAUMI)

PER/02/012016

RS.TRAUMA CENTRE

29/01/2016

31/12/2017

6

1500000000113

RUMAH SAKIT ISLAM WONOSOBO

JL MAYJEN BAMBANG SUGENG KM 03 MENDOLO BUMIRESO

322961

YAYASAN AMAL DAN KESEJAHTERAAN UMAT ISLAM (YAKAUMI)

PER/01/012015

RS.TRAUMA CENTRE

29/01/2016

31/12/2015

KANTOR CABANG

NO

KODE PROVIDER

:

L07- KANTOR CABANG TEGAL

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

DR M KARIM AMRULLAH

PER/09/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

DR SUHARJO

PER/10/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

52415

DR SUWASPODO

PER/16/2016

RS.TRAUMA CENTRE

22/02/2016

31/01/2017

JL PASAR BALAMOA RT 01/01 PANGKAH

52415

DAWAM RAHARJO

PER/17/012016

RS.TRAUMA CENTRE

22/02/2016

31/12/2016

KLINIK SEJAHTERA 1

DESA TEMBOK LOR RT 10/02 KEC ADIWERNA

52194

7608142

DR NAJMUL IMAN

PER/12/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

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

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

1

1500000001580

KLINIK AZ-ZAHRA

JL RAYA LEBAKSIU RT 02/03 LEBAKSIU LOR

2

1500000001579

KLINIK KS TUBUN 81

JL KS TUBUN NO 81 RT 01/01 KEL DEBONGTENGAH

3

7-2131721414

KLINIK MONAS WOUND CARE TEGAL

JL RAYA TALANG RT 11/02 TALANG

4

7-2131470963

KLINIK NAYAKA HUSADA 06 BALAMOA

5

1500000001755

6

7

MA11222I

081828983 6


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94 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

NO IKS

AKHIR IKS

01/01/2016

31/12/2016

PER/01/012015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

DR H. ACHMAD SHOCHIBUL BIRRI

PER/06/012016

RS.TRAUMA CENTRE

03/03/2016

31/12/2016

DR H M ABDUL DJALIL MKES

PER/11/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

PER/14/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

DR H FAISAL AMRI, SH

PER/07/0122016

RS.TRAUMA CENTRE

03/03/2016

31/12/2016

491991

DR WIDODO JOKO MULYONO, M,KES,MMR

PER/04/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

JL RAYA TEGAL-PEMALANG KM.12 SURADADI

3336263

PEMERINTAH KABUPATEN TEGAL

PER/08/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

JL ABABIL NO 42

353387

HABIYAH. MMR

PER/03/2015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

RS DEDY JAYA (TC)

JL AHMAD YANI NO 57

672525

9

1500000000186

RS MITRA SIAGA

JL PALA RAYA NO 54 KEC KRAMAT

322550

10

1000000000009

RSI PKU MUHAMMADIYAH KABUPATEN TEGAL(TC)

JALAN RAYA SINGKIL KM 0.5 ADIWERNA

3448180

11

1500000001754

RSU ADELLA

JL PROF MOH YAMIN NO 77 KEL KUDAILE KEC SLAWI

491154

12

01626

RSU KARDINAH TEGAL

JL KS TUBUN NO. 1 TEGAL

13

0800000000030

RSU SITI ASIYAH

JL PASAR WAGE BUMIAYU

41059007

14

0900000000035

RSUD DR SOESELO SLAWI (TC)

JL DR SUTOMO NO 63 SLAWI

15

1500000001236

RSUD SURADADI

16

0900000000029

RSUI HARAPAN ANDA (TC)

MA11222I

AWAL IKS

RS.TRAUMA CENTRE

0900000000036

:

TIPE IKS

PER/02/2015

8

KANTOR CABANG

PIMPINAN

52419

DR IRMA YURITA

L08- KANTOR CABANG KLATEN


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NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

NO IKS

JL. RAYA BOYOLALI SELO KM 5 JELOK CEPOGO

081393306 461

7-1549815415

KLINIK NAYAKA HUSADA 02 BOYOLALI

DK. BUTUH MOJOSONGO BOYOLALI

024760562 1

3

1500000000102

KLINIK PKU MUH JATINOM

JL RAYA JATINOM KLATEN KM 1 KLATEN

337334

4

1500000000688

KLINIK PKU MUHAMMADIYAH CAWAS

JL CAWAS PEDAN BELAKANG POLSEK CAWAS KLATEN

897661

5

1500000000688

KLINIK PKU MUHAMMADIYAH CAWAS

JL CAWAS PEDAN BELAKANG POLSEK CAWAS KLATEN

897661

6

1500000000444

KLINIK PKU MUHAMMADIYAH POLAN HARJO

JL COKRO DELANGGU GUDANG ABANG WANGEN POLANHARJO

557002

7

1500000000083

KLINIK PRATAMA RAWAT INAP MILA HUSADA

JL . RAYA PENGGING KM 02 BANYUDONO BOYOLALI

327453

8

1500000000293

KLINIK UPK PMI KLATEN

JL. VETERAN NO 80 KLATEN UTARA

9

1400000000147

RS HIDAYAH BOYOLALI

10

1400000000147

11

12

1

PIMPINAN TIPE IKS

AWAL IKS

AKHIR IKS

PER/24/112015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

PER/07/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

PER/06/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

PER/14/042016

RS.TRAUMA CENTRE

03/05/2016

31/12/2017

PER/14/04/2016

RS.TRAUMA CENTRE

02/05/2016

30/04/2017

PER/12/042016

RS.TRAUMA CENTRE

13/04/2016

31/03/2017

DR. H DIDIK SUPRAPTO

PER/05/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

8850400

DR TRI ARI SUSANTO

PER/009/032016

RS.TRAUMA CENTRE

03/03/2016

31/12/2017

KRAGILAN MOJOSONGO BOYOLALI

324614

YAYASAN DUA SEPTEMBER BOYOLALI

PER/18/052016

RS.TRAUMA CENTRE

01/06/2016

31/05/2017

RS HIDAYAH BOYOLALI

KRAGILAN MOJOSONGO BOYOLALI

324614

YAYASAN DUA SEPTEMBER BOYOLALI

PER/018/052016

RS.TRAUMA CENTRE

01/06/2016

31/12/2017

1500000000445

RS KARANGGEDE SISMA MEDIKA

JL RAYA KARENGGEDE SOLO KM 1 KEBONAN KARANGGEDE BOYOLALI

610600

PT SISMADI MEDCORPINDO BOYOLALI

PER/011/042016

RS.TRAUMA CENTRE

13/04/2016

31/03/2017

0800000000001

RSI KLATEN

JL YOGYA-SOLO KETANDAN KLATEN

PER/01/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

1400000000435

KLINIK INSAN SEHAT

2

MA11222I

57322

PT RESTU BUNDA YAYASAN DANA PENSIUN KARYAWAN BPJS KETENAGAKERJAAN YAYASAN MUHAMMADIYAH CAB JATINOM KLATEN YAYASAN MUHAMMADIYAH CABANG CAWAS YAYASAN MUHAMMADIYAH CABANG CAWAS PIMPINAN CABANG MUHAMMADIYAH POLANHARJO KABUPATEN KLATEN


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KODE PROVIDER

NAMA PROVIDER

ALAMAT

13

1500000000292

RSU ASY SYIFA SAMBI BOYOLALI

JL RAYA BANGAK SIMO KM 7 SAMBI BOYOLALI

14

7-1550676406

RSU CAKRA HUSADA KLATEN

JL. MERBABU NO 7

15

0800000000004

RSU PANDAN ARANG BOYOLALI

JL KANTIL 14 BOYOLALI

16

1100000000010

RSU PKU AISYIYAH BOYOLALI

JL. PASAR SAPI BARU SINGKILKARANGGENENG BOYOLALI

17

1100000000010

RSU PKU AISYIYAH BOYOLALI

JL. PASAR SAPI BARU SINGKILKARANGGENENG BOYOLALI

18

0800000000002

RSU SOERADJI TIRTONEGORO

JL SURADJI TIRTONEGORO

19

0800000000005

RSUD BANYUDONO

JL RAYA SOLO-SEMARANG

KANTOR CABANG

NO

KODE PROVIDER

:

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

YAYASAN KARTIKA HUSADA SAMBI

PER/010/03/2016

RS.TRAUMA CENTRE

03/03/2016

31/12/2017

PT CAKRA HUSADA

PER/08/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

PER/02/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

322898

PER/13/04/2016

RS.TRAUMA CENTRE

03/05/2016

31/12/2017

322898

PER/13/04216

RS.TRAUMA CENTRE

02/05/2016

30/04/2017

PER/04/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

PER/03/012016

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

3294459

57412

085647136 655

PEMDA

L09- KANTOR CABANG PURWOKERTO

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1400000000187

RSI PURWOKERTO

JL H MASYHURI NO 39 PURWOKERTO

630019

YARSI PURWOKERTO

PER/001/012016

RS.TRAUMA CENTRE

21/01/2016

31/12/2017

2

1500000000680

RSKB JATIWINANGUN

JL JATIWINANGUN NO 54 PURWOKERTO

638169

PT SANATIO

PER/006/012016

RS.TRAUMA CENTRE

27/04/2016

31/12/2017

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

3

1400000000238

RSUD AJIBARANG

JL RAYA PANCASAN

6570004

PER/002/012016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

4

1500000000118

RSUD PROF DR MARGONO SOEKARJO

JL DR GUMBREG NO 1 PURWOKERTO

632708

PER/005/022016

RS.TRAUMA CENTRE

25/04/2016

31/12/2018

5

7-3297996775

RUMAH SAKIT SIAGA MEDIKA

JL PRAMUKA 55 BANYUMAS

PER/010/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

KANTOR CABANG

NO

KODE PROVIDER

:

YAYASAN SIAGA SEJAHTERA

53192

L10- KANTOR CABANG UNGARAN

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000867

GRIYA PELATIHAN APAC (GRIPAC)

JL SOEKARNO HATTA KM.32 DESA HARJOSARI BAWEN

522914

PT APAC INTI CORPORA

PER/09/012016

RS.TRAUMA CENTRE

25/02/2016

31/12/2016

2

1400000000657

KLINIK APAC INTI CORPORA

JL SOEKARNO HATTA KM 32 HARJOSARI BAWEN

522888

H AGUNG WAHONO SH.MHUM

PER/06/012016

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

3

1500000001574

KLINIK PRATAMA "MANUNGGAL"

JL ARGO BUSONO NO.1

322480

KOPERASI PT DAMATEX

PER/08/012016

RS.TRAUMA CENTRE

25/02/2016

31/12/2016

4

1400000000656

KLINIK UMUM 24 JAM UMI HABIBAH

JL SYECH BASARUDIN KEL.NGEMPON, BERGAS

526225

SITI MUSRIYATUN

PER/05/012016

RS.TRAUMA CENTRE

13/01/2016

31/12/2016

5

7-2008582105

PUSKESMAS AMBARAWA

JL JENDRAL SUDIRMAN NO 76 KEC AMBARAWA KAB SEMARANG

50611

DINAS KESEHATAN KABUPATEN SEMARANG

PER/07/012016

RS.TRAUMA CENTRE

15/02/2016

31/12/2016

6

7-2008950288

PUSKESMAS BANCAK

JL JENDRAL SUDIRMAN NO 1 KEC BANCAK KAB SEMARANG

50125

DINAS KESEHATAN KAB SEMARANG

PER/07/012016

RS.TRAUMA CENTRE

15/02/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

7

7-2008215164

PUSKESMAS BANYUBIRU

JL WIJAYA KUSUMA 47 KEC BANYUBIRU KAB SEMARANG

8

1500000000341

PUSKESMAS BAWEN

JL PALAGAN NO. 60 KEC. BAWEN

9

1500000000340

PUSKESMAS BERGAS

JL SOEKARNO HATTA KEC.BERGAS

10

7-2008826037

PUSKESMAS BRINGIN

JL DIPONOGORO NO 141 BRINGIN KEC BRINGIN KAB SEMARANG

50218

11

7-1990357685

PUSKESMAS DADAPAYAM

JL RAYA DADAPAYAM NO.79, KEC SURUH

50186

12

1500000000338

PUSKESMAS DUREN

JL KENDALISODO NO.19 KEC.BANDUNGAN

13

7-2006436553

PUSKESMAS GEDANGAN

JL RAYA SALATIGA MUNCUL KM 3 KEC TUNTANG KAB SEMARANG

14

1500000000325

PUSKESMAS GETASAN

15

1500000000337

16

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS


PER/07/012016

RS.TRAUMA CENTRE

15/02/2016

31/12/2016

591539

DINAS KESEHATAN KAB.SEMARANG

PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

6525695


PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016


PER/07/012016

RS.TRAUMA CENTRE

15/02/2016

31/12/2016

029871088 02


PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

711355


PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

024692123 8

DINKES KAB SEMARANG

PER/07/012016

RS.TRAUMA CENTRE

15/02/2016

31/12/2016

JL RAYA SALATIGA KOPENG KM 10 KEC.GETASAN

2838099


PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

PUSKESMAS JAMBU

JL. RAYA SEMARANG MAGELANG KM 4 KEC.JAMBU

593532


PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

7-1989943593

PUSKESMAS JETAK

DS.JETAK , KEC.GETASAN

50774

029831466 4

DINKES KAB SEMARANG

PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

17

7-2008732846

PUSKESMAS JIMBARAN

JL TEGAL PANAS JIMBARAN KEC BAWEN KAB SEMARANG

50661


PER/07/012016

RS.TRAUMA CENTRE

15/02/2016

31/12/2016

18

7-1990221924

PUSKESMAS KALIWUNGU

JL AMPEL SIMO 186, KEC.KALIWUNGU

50221

DINKES KAB SEMARANG

PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

MA11222I

50664

50131

027633312 13


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

19

7-2009520872

PUSKESMAS KALONGAN

JL ARJUNA NO 2 KE UNGARAN TIMUR KAB SEMARANG

50514


PER/07/012016

RS.TRAUMA CENTRE

15/02/2016

31/12/2016

20

7-2009063660

PUSKESMAS LEREP

JL YUDISTIRA RAYA KM 3 KEC UNGARAN TIMUR KAB SEMARANG

50514


PER/07/012016

RS.TRAUMA CENTRE

15/02/2016

31/12/2016

21

7-2009405851

PUSKESMAS LEYANGAN

JL PUSKESMAS NO 1 KEC UNGARAN BARAT KAB SEMARANG

50512


PER/07/012016

RS.TRAUMA CENTRE

15/02/2016

31/12/2016

22

7-1990444836

PUSKESMAS PABELAN

JL PEMUDA NO.98 PABELAN, KEC,PABELAN

50771

029832112 4


PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

23

1500000000339

PUSKESMAS PRINGAPUS

JL.HONGOWICONO NO.5 KEC. PRINGAPUS

25721150

DNIAS KESEHATAN KAB.SEMARANG

PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

24

7-1990583417

PUSKESMAS SEMOWO

DS SEMOWO , KEC. PABELAN

029871009 85


PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

25

1500000000336

PUSKESMAS SUMOWONO

JL.PAHLAWAN NO.15 KEC SUMOWONO

40575050


PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

26

1500000000343

PUSKESMAS SURUH

JL RAYA SURUH PLUMBON KEC SURUH

2882262


PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

27

1500000000342

PUSKESMAS SUSUKAN

JL RAYA SUSUKAN NO.96 KEC SUSUKAN

615066


PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

28

1500000000344

PUSKESMAS TENGARAN

JL RAYA SALATIGA SOLO KM 9 KEC. TENGARAN


PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

29

7-1990928198

PUSKESMAS TUNTANG

JL FATMAWATI NO.47, KEC TUNTANG

50131


PER/07/012016

RS.TRAUMA CENTRE

12/02/2016

31/12/2016

30

7-2009013889

PUSKESMAS UNGARAN

JL AHMAD YANI NO 2-3 KEC UNGARAN KAB SEMARANG

50511


PER/07/012016

RS.TRAUMA CENTRE

15/02/2016

31/12/2016

MA11222I

50771

029834000 7


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

31

1400000000016

RS PURI ASIH

JL JEND.SUDIRMAN NO. 169

323209

DR MUFTI SIRADJ,SPOG

PER/04/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

32

1400000000019

RSUD AMBARAWA

JL KARTINI NO. 101 AMBARAWA

591020

PEMDA KAB SEMARANG

PER/02/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

33

7-1395288578

RSUD KOTA SALATIGA

JL OSAMALIKI NO. 19 SALATIGA

PEMKOT SALATIGA

PER/03/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

34

01728

RSUD SALATIGA

JL OSAMALIKI NO 19 SALATIGA

324074

KOTA MAGELANG

PER/03/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

35

1400000000018

RSUD UNGARAN

JL DIPONEGORO NO. 125 UNGARAN

6921006

PEMDA KAB.SEMARANG

PER/01/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

KANTOR CABANG

NO

KODE PROVIDER

:

L11- KANTOR CABANG SEMARANG KALIGAWE

NAMA PROVIDER

ALAMAT

1

1500000001891

KLINIK 24 JAM DELIMA SEHAT

JL FATMAWATI NO 21A SEMARANG

2

1500000001494

KLINIK KAWAN SEJATI

3

1500000001534

4

1500000001532

MA11222I

50721

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

6734367

DR. DODI WITJAKSONO

PER/15/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

DS KARANGSARI RT 01/04 KARANGTENGAH DEMAK

089671458 335

NINDYA ANGGI SINANTARA

PER/09/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

KLINIK PRATAMA DWI PUSPITA KALIGAWE

JL. RAYA KALIGAWE KM 7 NO 9 TRIMULYO SEMARANG

082180099 759

HJ. ANISFA BAKAR

PER/12/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

KLINIK PRATAMA DWI PUSPITA KARANGAWEN

JL. BRAMBANG NO 217 RT 05/02 BRAMBANG - DEMAK

082180099 759

HJ. ANISFA BAKAR

PER/10/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

50111


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

5

1500000001533

KLINIK PRATAMA DWI PUSPITA PEDURUNGAN

JL. BRIG.JEND. SUDIARTO NO 512 SEMARANG

082180099 759

HJ. ANISFA BAKAR

PER/11/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

6

1400000000261

KLINIK PRATAMA NAYAKA ERA HUSADA 03

JL RAYA KALIGAWE KM5,5

70572297

PT NAYAKA ERA HUSADA SEMARANG

PER/04/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

7

1500000001381

KLINIK PRATAMA NAYAKA HUSADA 04

JL SEMARANG-DEMAK KM 15 WONOKERTO KARANGTENGAH DEMAK

7605621


PER/08/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

8

1500000001380


JL SULTAN FATAH NO 47 DEMAK

7605621


PER/07/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

9

1500000001807

KLINIK PRATAMA RAWAT INAP KELUARGA SAKINAH

JL TELAGA KENCANA RAYA NO 15 BATURSARI MRANGGEN DEMAK

76580381

DR. AISYAH LAHDJI

PER/14/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

10

1500000001539

KLINIK PRATAMA SAYUNG HUSADA DEMAK

JL. RAYA SAYUNG KM 10 SAYUNG - DEMAK

6591137

DR. FUAD ALHAMIDY

PER/13/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

11

1500000001333

KLINIK PRATAMA SEHAT UTAMA

JL. MEDOHO RAYA NO 21 SAMBIREJO SEMARANG

6719222

HJ. SRI WAHYUNI MAHMUD, AM

PER/06/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

12

1300000000006

RS ISLAM NU DEMAK (RS TRAUMA CENTER JKK)

JL JOGOLOYO NO 09 DEMAK

685723

DR NUNUK SRI LESTARI

PER/02/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

13

1100000000006

RS ISLAM SULTAN AGUNG (RS TRAUMA CENTER JKK)

JL RAYA KALIGAWE KM 4 SEMARANG

6580019

DR MASYHUDI,MSI

PER/01/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2017

14

1300000000033

RS PANTI WILSA CITARUM SEMARANG (RSTC JKK)

JL CITARUM NO 98 SEMARANG

3546040

DR SUSETYO, SPA

PER/03/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

15

1400000000402

RSUD SUNAN KALIJAGA (RSTC)

JL. SULTAN FATAH 669/50 DEMAK

685018

RSUD KAB. DEMAK

PER/05/012016

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

KANTOR CABANG

MA11222I

:

N00- KANTOR CABANG SURABAYA KARIMUNJAWA


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000715

ANUGERAH KARYA MEDIKA CEMENGKALANG SIDOARJO

RUKO PURI INDAH BLOK 30,JATICEMENGKALANG-SIDOARJO

031715542 59

SUSILO HENDROWARSITO

PER/09/012015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

2

1500000000717

ANUGERAH KARYA MEDIKA DEMAK

JL. DEMAK 375 SURABAYA

081130514 3

CV. ANUGERAH KARYA MEDIKA

PER/09/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

3

1500000000720

ANUGERAH KARYA MEDIKA GUNUNGSARI

JL. GUNUNGSARI NO.124 SURABAYA

5675589

CV. ANUGERAH KARYA MEDIKA

PER/09/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

4

1500000000712

BP 14

JL. PUCANG ANOM TIMUR NO. 35 SURABAYA

70701255

DR SURANADI SUGANDA

PER/10/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

5

1500000001466

BRAIN CLINIC

JL. SULAWESI NO.63 SURABAYA

5018800

PT. NEURO SENTRA HUSADA

PER/11/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

6

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

7

1500000001031

KLINIK ABDI MULIA WISMA PERMAI

JL. WISMA PERMAI BARAT III/FP 12 SURABAYA

0315944122

YAYASAN ABDI MULIA

PER/12/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

8

1500000000719

KLINIK HEALTHY

JL NGAGEL TIRTO 25-27

5040990

KLINIK BEDAH & PRAKTEK DR HEALTHY

PER/13/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

9

1500000001071

KLINIK KENCANA MEDIKA

JL. KENDANGSARI NO. 78 SURABAYA

8498880

KLINIK KENCANA MEDIKA

PER/14/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

10

1500000000716

KLINIK MEDIS AMBENGAN

JL.AMBENGAN 35 SURABAYA

081832211 9

CV. KARYA PUTRA AMBENGAN

PER/15/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

11

1500000001072

KLINIK MEDPOINT

JL. RAYA LONTAR 229 SURABAYA

7524067

KLINIK MEDPOINT

PER/16/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

12

1500000001487

KLINIK MODERN DASA MEDIKA

JL. DIPONEGORO NO 161-163 SURABAYA

5677088

PT.PERKEBUNAN NUSANTARA X (PERSERO)

PER/06/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I


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KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

13

1400000000445


JL RAYA KRIKILAN NO 259 DRIYOREJO GRESIK

7887273


PER/17/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

14

1400000000450


JL RA KARTINI NO 236 C-9 KEBOMAS GRESIK

7887273


PER/17/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

15

1400000000449


RUKO SEPANJANG TOWN HOUSE C1-C3 JL KALIJATEN

7887273


PER/17/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

16

1500000000713

KLINIK PRATAMA 65

JL. GUBENG KERTAJAYA X1/38 SURABAYA

088835356 66

DR ADRIANUS MICHAEL FOEH

PER/18/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

17

1500000000718

KLINIK PRATAMA ALAMANDA

JL. DINOYO NO.20-II

5677767

CV. INTI PRATAMA

PER/17/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

18

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

19

1400000000443

KLINIK PRATAMA NAYAKA 02

JL MASTRIP NO 150 KEBRAON SURABAYA

7887273


PER/17/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

20

1400000000439


JL CENDRAWASIH NO 28B

7887273


PER/17/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

21

1400000000446


JL ASEM ROWO KALI NO 1

7887273


PER/17/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

22

1400000000447


JL PANDEGILING NO 117A

7887273


PER/17/012015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

23

1400000000448


JL TANDES ASRI NO 64

7887273


PER/17/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

24

1400000000451


JL KALI RUNGKUT NO 52

7887273


PER/17/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I


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ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

25

1500000001483

KLINIK PRATAMA PG KREMBOONG

DESA KREMBOONG SIDOARJO

081332074 648

PTPN X

PER/06/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

26

1500000001483

KLINIK PRATAMA PG KREMBOONG

DESA KREMBOONG SIDOARJO

081332074 648

PTPN X

PER/24/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

27

1500000001484

KLINIK PRATAMA PG TOELANGAN

DESA TULANGAN SIDOARJO

PTPN X

PER/06/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

28

1500000001484

KLINIK PRATAMA PG TOELANGAN

DESA TULANGAN SIDOARJO

PTPN X

PER/24/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

29

1500000001485

KLINIK PRATAMA PG WATOETOELIS

DESA TEMU KECAMATAN PRAMBON SIDOARJO

081332074 648

PTPN X

PER/06/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

30

1500000001485

KLINIK PRATAMA PG WATOETOELIS

DESA TEMU KECAMATAN PRAMBON SIDOARJO

081332074 648

PTPN X

PER/24/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

31

1500000001486

KLINIK ST.VINCENTIUS A PAULO (KARAH)

JL. KARAH NO.200 SURABAYA

5677562

YAYASAN ARNOLDUS

PER/20/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

32

1500000001029

KLINIK UTAMA KASIH KARUNIA

JL. RAYA SATELIT BARAT AS NO.1 SURABAYA

7327688

YAYASAN KASIH KARUNIA

PER/21/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

33

7-2646874297

RS ADI HUSADA KAPASARI

JL. KAPASARI 97-101 SURABAYA

031376455 5

PERKUMPULAN ADI HUSADA

PER/28/032016

RS.TRAUMA CENTRE

24/03/2016

31/12/2016

34

1500000000478

RS BHAKTI DHARMA HUSADA

JL RAYA KENDUNG NO 115-117

7404444

PEMERINTAH KOTA SURABAYA

PER/07/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

35

0700000000013

RS BHAYANGKARA HS SAMSOERI M

JL. A YANI NO. 116 SURABAYA

8292227

POLDA JATIM

PER/01/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

36

1500000000714

RS MARINIR EWA PANGALILA GUNUNGSARI

JL GOLF I NO 1A SURABAYA

0315663539

TNI ANGKATAN LAUT

PER/02/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I

60141


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NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

37

1500000001385

RS MATA UNDAAN

JL UNDAAN KULON 17-19 SURABAYA

5343806

RS MATA UNDAAN

PER/22/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

38

1500000000549

RS TINGKAT III BRAWIJAYA

JL KESATRIAN NO 17

5611272

KODAM V BRAWIJAYA

PER/03/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

39

1500000000187

RS TNI AU SOEMITRO SURABAYA

JL. SERAYU NO 17 SURABAYA

5662593

TNI AU

PER/04/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

40

1500000001384

RS UNIVERSITAS AIRLANGGA

KAMPUS C MULYOREJO UNIVERSITAS AIRLANGGA SBY

8439473

UNIVERSITAS AIRLANGGA

PER/08/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

41

7-2646874299

RS WILLIAM BOOTH SURABAYA

JL. DIPONEGORO NO.34 SURABAYA

031567891 7

YAYASAN PELAYANAN KESEHATAN BALA KESELAMATAN

PER/25/032016

RS.TRAUMA CENTRE

24/03/2016

31/12/2016

42

1500000000711

RS.DKT GUBENG POJOKBANTUAN 05.08.05 SURABAYA

JL. GUBENG POJOK NO.21

5310069

DRG.OUTI

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

43

7-2743409383

RSUD DR SOETOMO

JL. MAYJEND PROF. DR. MOESTOPO NO. 6 8 SURABAYA

5501770-72

PEMPROV JATIM

PER/27/032016

RS.TRAUMA CENTRE

31/03/2016

31/12/2016

44

1400000000360

RUMAH SAKIT SURABAYA MEDICAL SERVICE

JL. KAPUAS NO.2 SURABAYA

5686161

YAYASAN PUJA HUSADA

PER/23/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

45

7-2884678195

SILOAM HOSPITALS SURABAYA

JL. GUBENG NO 70 SURABAYA

031 503 1333

PT. SILOAM INTERNATIONAL HOSPITALS SURABAYA

PER/29/042016

RS.TRAUMA CENTRE

12/04/2016

31/12/2016

46

1500000001201

UPT PELATIHAN KERJA SURABAYA

JL.DUKUH MENANGGAL III/29 SURABAYA

8290071

DRS. WIDJIL SAPTADI

PER/18/052015

RS.TRAUMA CENTRE

01/01/2016

19/05/2016

KANTOR CABANG

MA11222I

:

60241

60286

60281

N01- KANTOR CABANG KEDIRI


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KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1000000000008

RS BHAYANGKARA KEDIRI

JL.KOMBES POL. DURYAT NO. 17 KEDIRI

POLRI

PER/24/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

2

1000000000008

RS BHAYANGKARA KEDIRI

JL.KOMBES POL. DURYAT NO. 17 KEDIRI

POLRI

PER/33/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

3

07189

RS BHAYANGKARA NGANJUK

JL. ABDUL RAHMAN SALEH NO. 52-56

3218896

PER/23/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

4

1500000000725

RSU AURA SYIFA

JL. JOYOBOYO NO. 42 DLOPO KEC. NGASEM KABUPATEN KEDIRI

671939

RSU AURA SYIFA

PER/31/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

5

0800000000031

RSUD GAMBIRAN

JL.K.H.WAHID HASYIM NO 64

773097

DR.ENDANG WAHYU L,MARS

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

6

1500000001542

RSUD KABUPATEN KEDIRI

JLN. PAHLAWAN KUSUMA BANGSA NO. 1 PARE KEDIRI

391718

RSUD KABUPATEN KEDIRI

PER/29/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

1400000000564

RSUD KERTOSONO

JL. SUPRIYADI NO. 29 KERTOSONO

551118

RUMAH SAKIT UMUM DAERAH KERTOSONO

PER/25/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

8

1500000000863

RUMAH SAKIT BEDAH ARGA HUSADA

DS BRANGGAHAN KEC NGADILUWIH KABUPATEN KEDIRI

476376

YAYASAN ARGA HUSADA UTAMA

PER/28/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

9

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

10

1400000000206

RUMAH SAKIT MUHAMMADIYAH AHMAD DAHLAN

JL. GATOT SUBROTO 84 KOTA KEDIRI

773115

MKKM PD MUHAMMADIYAH KOTA KEDIRI

PER/27/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

11

1500000000723

RUMAH SAKIT MUHAMMADIYAH SITI KHODIJAH

JL. DR.SUTOMO NO.322 SUKOREJO KEC.GURAH KABUPATEN KEDIRI

545481

RUMAH SAKIT MUHAMMADIYAH SITI KHODIJAH

PER/32/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

KANTOR CABANG

MA11222I

:

N02- KANTOR CABANG MALANG


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KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

7-2441622873

G AND G HEALTH CLINIC

JLN. TERUSAN KAWI NO. 9 KAV. 9

65119

341 568527

DR. FM. VALENTINA, SH M. HUM

PER/16/032016

RS.TRAUMA CENTRE

11/03/2016

31/12/2016

2

7-2738145733

KLINIK NAYAKA HUSADA NO.05

JLN. RAYA JABUNG RT/ W 003/002 DESA JABUNG KECAMATAN JABUNG

65155

341794735


PER/18//032016

RS.TRAUMA CENTRE

30/03/2016

31/12/2016

3

7-2553159943

KLINIK SEHAT24

JLN. RAYA KARANGPLOSO KEPUHARJO RUKO BALITAS KAV. 7

65152

341 5034129

SUJIATI JS

PER/17/032016

RS.TRAUMA CENTRE

17/03/2016

31/12/2016

4

1300000000016

RS. BAPTIS BATU

JL. RAYA TLEKUNG NO.1 JUNREJO

594161

YAYASAN BAPTIS INDONESIA

PER/01/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

5

1200000000012

RS. BHAYANGKARA HASTA BRATA

JL. RA KARTINI NO. 01

597023

PER/03/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

6

1200000000008

RS. WAVA HUSADA

JL. PANGLIMA SUDIRMAN NO. 99 A DILEM KEPANJEN

393000

ABNASAMANHUDI SAUTIKA HUSADA PT

PER/11/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

1500000000046

RSI GONDANGLEGI

JL HAYAM WURUK NO 66 GONDANGLEGI

879047

YAYASAN RS GONDANGLEGI

PER/04/01/01201 6

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

8

1400000000002

RSU ISLAM MADINAH

JL. RAYA SUKOSARI 32 KASEMBON

326688

YAY AL MADINAH

PER/12/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

9

1200000000009

RSU. LAWANG MEDIKA

JL. DR. CIPTO NO. 08 BEDALI LAWANG

426705

PT. DASA USAHA JAYA

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

10

1200000000010

RSU. PRASETYA HUSADA

JL. RAYA NGIJO NO. 25 KARANG PLOSO

460558

SUJIATI, SST,MM.KES

PER/08/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

11

7-3039817013

RSUD KANJURUHAN KEPANJEN

JLN. PANJI NOMOR 100

341395041

PEMERINTAH KABUPATEN MALANG

PER/22/012016

RS.TRAUMA CENTRE

25/04/2016

20/12/2016

12

1000000000011

RUMAH SAKIT MARSUDI WALUYO

JL.RAYA MONDOROKO KM 9 SINGOSARI MALANG

458919

DR.KRISTIWI HANGGRIYANI

PER/06/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I

65163


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NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

13

1000000000011

RUMAH SAKIT MARSUDI WALUYO

JL.RAYA MONDOROKO KM 9 SINGOSARI MALANG

458919

DR.KRISTIWI HANGGRIYANI

PER/14/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

14

1000000000013

RUMAH SAKIT PANTI NIRMALA

JL.KEBALEN WETAN NO.8

331100

DRG.BENNY ANDOKO WIBISONO

PER/ 07/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

15

1000000000012

RUMAH SAKIT PRIMA HUSADA

JL.BANJARARUM SELATAN NO 3 MONDOROKO-SINGOSARI MALANG

458679

DR.SADI HARIONO

PER/09/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

16

1200000000011

RUMAH SAKIT UMUM BEN MARI

JL. RAYA KENDAL PAYAK NO 17 PAKISAJI

837777

PT. RS BEN MARI

PER/02/012015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

17

1400000000001

RUMAH SAKIT UMUM DAERAH DR. SAIFUL ANWAR

JL. JAKSA AGUNG SUPRAPTO

362101

PEMPROV JATIM

PER/09/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

18

1400000000001

RUMAH SAKIT UMUM DAERAH DR. SAIFUL ANWAR

JL. JAKSA AGUNG SUPRAPTO

362101

PEMPROV JATIM

PER/10/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

19

7-1238038834

RUMAH SAKIT UMUM KARSA HUSADA BATU

JLN. A . YANI 10-13

341591036

PROVINSI

PER/13/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

20

1500000001316

UPT PELATHAN KERJA SINGOSARI

JL. RAYA SINGOSARI

458055

UPT PELATHAN KERJA SINGOSARI

PER/15/012016

RS.TRAUMA CENTRE

04/02/2016

31/12/2016

KANTOR CABANG

NO

1

KODE PROVIDER

1400000000625

MA11222I

:

65311

N03- KANTOR CABANG JEMBER

NAMA PROVIDER

RS BHAYANGKARA BONDOWOSO

ALAMAT

JL JEND POL SUCIPTO JUDODIHARJO NO 12 BONDOWOSO

KODE POS

IKS TELEPON

PIMPINAN NO IKS

082336624 828

DR EKA WARDHANI

PER/22/122015



AWAL IKS 01/01/2016


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

NO IKS

2

1500000001561

RS BHAYANGKARA TK III LUMAJANG

JL KYAI ILYAS NO 07 TOMPOKERSAN LUMAJANG

3

7-1672273183

RS CITRA HUSADA

JL. TERATAI NO. 22 DS. GEBANG KEC. PATRANG KOTA JEMBER

4

7-1672273183

RS CITRA HUSADA

JL. TERATAI NO. 22 DS. GEBANG KEC. PATRANG KOTA JEMBER

5

1400000000626

RS ISLAM LUMAJANG

JL KYAI MUKSIN 19 LUMAJANG

6

7-1692033973

RS JEMBER KLINIK

JALAN BEDADUNG NO.2 JEMBER LOR PATRANG JEMBER

7

1500000000647

RSD DR SOEBANDI

JL DR SOEBANDI NO 124

487441

8

1400000000009

RSU KALIWATES JEMBER

JL DIAH PITALOKA NO 4 A JEMBER

485967

9

7-1938064553

RSUD DR HARYOTO KAB LUMAJANG

JL BASUKI RAHMAD NO 5 LUMAJANG

033488166 6

KANTOR CABANG

NO

1

KODE PROVIDER

1500000001062

MA11222I

:

PIMPINAN TIPE IKS

AWAL IKS

AKHIR IKS

88646

POLDA JATIM

PER/10/062015

RS.TRAUMA CENTRE

01/06/2016

31/05/2017

68117

033148620 0

YAYASAN CITRA HUSADA

PER/4/012016

RS.TRAUMA CENTRE

01/02/2016

31/12/2016

68117

033148620 0

YAYASAN CITRA HUSADA

PER/004/012016

RS.TRAUMA CENTRE

01/02/2016

31/01/2017

887999

DR R ELYUNAR DWI NUGROHO

PER/20/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

033148710 4

PT NUSANTARA MEDIKA UTAMA

PER/05/012016

RS.TRAUMA CENTRE

28/01/2016

31/12/2016

PER/09/2016

RS.TRAUMA CENTRE

01/04/2016

31/12/2017

PT ROLAS NUSANTARA MEDIKA

PER/21/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

PEMPROV

PER/007/022016

RS.TRAUMA CENTRE

22/02/2016

31/12/2016

68111

67311

N04- KANTOR CABANG PASURUAN

NAMA PROVIDER

BP JAMSOSTEK 22

ALAMAT

JL. PUCANGSARI, SENGONAGUNG, PURWOSARI

KODE POS

IKS TELEPON

PIMPINAN NO IKS

7764043

CV CITRA MEDIKA

IKS/09/012016



AWAL IKS 01/01/2016


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KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

2

1500000001061

BP JAMSOSTEK 51

JL. TONGKOL NO. 2C, BANGIL

747731

CV CITRA MEDIKA

IKS/10/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

3

1500000001336

KLINIK CITRA 10

JL. RAYA JAPANAN, GG.BANDENG PRESATO NO.2, GEMPOL

854335

CV CITRA MEDIKA

IKS/11/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

4

1500000001340

KLINIK CITRA 2

JL. RAYA DRINGU GG.MARGOMULYO NO.2

843346

CV CITRA MEDIKA

IKS/15/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

5

1500000001339

KLINIK CITRA 6

JL. MASTRIP GG.KELAPA GADING NO. 43

4430181

CV CITRA MEDIKA

IKS/14/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

6

1500000001338

KLINIK CITRA PURWOSARI

JL. RAYA PURWOSARI NO. 21,

612244

CV CITRA MEDIKA

IKS/13/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

1500000001337

KLINIK JAMSOSTEK CITRA 1

JL. RAYA NGOPAK NO. 8, REJOSO

482366

CV CITRA MEDIKA

IKS/12/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

8

1500000001045

KLINIK MITRA 125

GG LONDO NO. 22A, JAGIL, GAMBIRAN, PRIGEN

881459

CV MITRA HUSADA

IKS/08/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

9

1500000001040

KLINIK MITRA 82

RUKO PERUM ISTANA BESTARI, JL. DR. WAHIDIN SUDIROHUSODO KEL. TAMANAN, KEC. BUGUL KIDUL,

6640508

CV. MITRA HUSADA

IKS/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

10

1500000001044

KLINIK MITRA 91

JL. RAYA GONDANG LEGI NO. 04, BEJI

655291

CV MITRA HUSADA

IKS/07/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

11

1500000001043

KLINIK MITRA 95

JL. STADION 28 PANDAAN / JL. PATTIMURA

636028

CV MITRA HUSADA

IKS/06/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

12

1500000001052

KLINIK RAWAT INAP ISLAM AISYIYAH

JL. PAHLAWAN SUNARYO 257, KUTOREJO, PANDAAN

637367

IKS/04/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

13

1500000001233

RS RIZANI HUSADA

JL. RAYA KOTAANYAR NO. 42

773444

IKS/16/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I

PT RIZANI HUSADA


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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

14

1400000000264

RSI MASYITHOH

JL. A. YANI NO. 6-7, BANGIL

741018

YAYASAN

IKS/01/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

15

1500000000087

RSUD TONGAS

JL RAYA TONGAS 229

511836

DRG KAMALIYAH TJIPLUK P.L, MMKES

IKS/02/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

KANTOR CABANG

NO

KODE PROVIDER

:

N05- KANTOR CABANG MOJOKERTO

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR 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

1500000000346

KLINIK ASY-SYIFA

JL RAYA PLOSO DS REJOAGUNG KEC PLOSO

61453

885995

DR ELDYANTO YUYUN

PER/55/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

3

1500000001603

KLINIK CITA MULIA

PERUM WIKARSA BLOK G NO1 KENANTEN PURI

61311

323302

CV GALUH MERALDA

PER56/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

4

1500000001606

KLINIK EMMA

JL JETIS TAMA NO 3 GRIYA JETIS PERMAI

61352

CV BANGUN SESAMA DAMAI SEJAHTERA

PER/46/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

5

1400000000107

KLINIK INDUSTRI MEDIKA

RUKO NGORO INDUSTRI PERSADA KAV A4A6

61385

6817979

MARIA MEILITASARI HARLIN DR, SPPD, MARS

PER/54/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

6

1500000001597

KLINIK KELUARGA BAHAGIA

JL RAYA BADUNG DSN BADUNG DS KEDUNGLENGKONG

61371

513355

NOVEL MOHAMMAD RAMZY PUTRA

PER/45/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

1500000001604

KLINIK MITRA 14 PERAK

DSN GADING DS GADINGMANGU KEC PERAK

61461

DR WARTIK

PER/51/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

DR BETTY ENDAH WARNI MKES

PER/53/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

DR MERIDIAN GEODESI

PER/47/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

DR WIWIET SARASWATI

PER/52/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

492876

CV MITRA HUSADA

PER/49/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

363786

IR H TEUKU ISMAIL

PER/50/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

61384

SITI NUR HIDAYATI ST MKES

PER/44/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

RAYA TRAWAS DSN WRINGINANOM DS MOJOREJO

61384

SITI NUR HIDAYATI ST MKES

PER/43/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

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

0900000000027

RS EMMA (RS TC)

JL RAYA IJEN NO 67

61311

032132873 7

DR MAGDALENA SITORUS

PER/64/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

17

1500000000353

RS GATOEL

JL RADEN WIJAYA NO 56 KRANGGAN, PRAJURIT KULON

61319

328557

PT NUSANTARA MEDIKA UTAMA

PER/63/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

18

1500000000927

RS KAMAR MEDIKA

JL EMPUNALA NO 351 KEDUNDUNG MAGERSARI

330066

PT WAK KAMAR MEDIKA HOSPITAL

PER/65/122015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

19

1500000000925

RS MUTIARA HATI

JL RAYA KEMANTREN WETAN NO 49 TERUSAN GEDEG

363442

SULFAKAR DR SPOG

PER/66/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

8

1500000001607

KLINIK MITRA 39

JL RAYA DIWEK NO 39 KEC DIWEK

61471

9

1500000001598

KLINIK PRATAMA MITRA 12

JL ANGGREK NO 24 CANDIMULYO

61411

10

1500000001605


JL PANGLIMA SUDIRMAN NO 26 KEC PLOSO

61453

11

1500000001599


JL RAYA TROWULAN NO132 KEC TROWULAN

61362

12

1500000001600


JL RAYA JETIS NO 14

61352

13

1500000001595

KLINIK PRATAMA SURYA HUSADA 2

JL RAYA PRAMBON DS NGIMBANG MOJOSARI

14

1500000001596

KLINIK SURYA HUSADA

15

1500000001608

16

MA11222I

61351

878318


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

878700

PT RUMAH SAKIT NAHDLATUL ULAMA JOMBANG

PER/69/122015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

61411

877945

PT PELANGKAP MEDICA SEJAHTERA

PER/68/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

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

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

1500000001523

RSI HASANAH

JL HOS COKROAMINOTO NO 26-28 MOJOKERTO

PER/70/122015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

25

1500000001621

RSI JOMBANG

JL BRIGJEN KRETARTO NO 22 A

61411

860074

PER/58/122015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

26

0800000000033

RSI SAKINAH (RS TC)

JL R A BASUNI NO 12

61361

321922

PER/61/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

27

0800000000010

RSUD. PROF. DR. SOEKANDAR (RS TC)

JL HAYAM WURUK NO 25 MOJOSARI

61382

591591

PER/59/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

28

1500000000347

RUMAH SAKIT KRISTEN MOJOWARNO

JL MERDEKA NO 59 MOJOWARNO

61475

495093

PER/57/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

20

1500000001594

RS NAHDLATUL ULAMA JOMBANG

JL KH HASYIM ASYARI NO 211

21

1500000001522

RS PELENGKAP MEDICAL CENTER

JL IR JUANDA NO 03

22

0800000000011

RS SIDO WARAS (RS TC)

23

0800000000034

24

KANTOR CABANG

MA11222I

:

321635

PIMPINAN WILAYAH MUHAMMADIYAH JAWA TIMUR YAYASAN AMAL SHOLEH IKATAN PERSAUDARAAN HAJI INDONESIA DR SULAIMAN ROSYID

YAYASAN KESEHATAN GKJW

N06- KANTOR CABANG BANYUWANGI


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000827

KLINIK BRAWIJAYA

JL BRAWIJAYA NO 46 KEBALENAN

423711

DR EDI HERMANTO

PER/07/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

2

1500000000832

KLINIK KHADIJAH PKU MUHAMMADIYAH MUNCAR

JL BRAWIJAYA 23A MUNCAR

592890

PIMPINAN CABANG MUHAMMADIYAH MUNCAR

PER/08/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

3

7-1989906563

RS NAHDLATUL ULAMA BANYUWANGI

JL RAYA MANGIR NO 09 KEC ROGOJAMPI

632965000

PC NAHDLATUL ULAMA KABUPATEN BANYUWANGI

PER/11/012016

RS.TRAUMA CENTRE

11/02/2016

31/12/2016

4

1200000000005

RS YASMIN

JL LETKOL ISTIQLAH 80-84

421198

YAYASAN SUMBER WARAS

PER/01/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

5

1400000000010

RSU BHAKTI HUSADA KRIKILAN

KRIKILAN GLENMORE

821118

PT ROLAS NUSANTARA MEDIKA

PER/02/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

6

1500000001552

RSUD ASEMBAGUS SITUBONDO

JL RAYA ASEMBAGUS KECAMATAN ASEMBAGUS

452193

PER/06/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

1500000001392

RSUD BESUKI

JL OLAHRAGA NO 55 BESUKI

891118

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

8

1400000000672

RSUD BLAMBANGAN BANYUWANGI

JL LETKOL ISTIQLAH BANYUWANGI

421118

PER/03/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

9

1500000000826

RSUD GENTENG BANYUWANGI

JL HASANUDDIN NO 98 GENTENG

845839

PER/04/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

10

1500000001576

UPT PELATIHAN KERJA SITUBONDO

JL BASUKI RAHMAT NO 357

672054

PER/09/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

KANTOR CABANG

MA11222I

:

68462

PEMDA BANYUWANGI

N07- KANTOR CABANG MADIUN


SM0480



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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000786

PUSKESMAS BALEREJO

JL RAYA MADIUN SURABAYA NO 82 DS BALEREJO KEC BALEREJO

383798

PER/16/092016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

2

1500000000774

PUSKESMAS BANGUNSARI

JL PANJANG PUNJUNG DS DOLOPO KEC.DOLOPO

368601

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

3

1500000000938

PUSKESMAS BANJAREJO

JL. BAYANGKARA NO.1 KEL BANJAREJO KEC. TAMAN

456322

PER/17/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

4

1500000000780

PUSKESMAS DAGANGAN

JL RAYA DAGANGAN PAGOTAN NO 57 DS DAGANGAN KEC DAGANGAN

367079

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

5

1500000000939

PUSKESMAS DEMANGAN

JL. SOEKARNO HATTA NO. 47 KEL. DEMANGAN KEC. TAMAN

464308

PER/17/05/2016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

6

1500000000784

PUSKESMAS DIMONG

JL RAYA DIMONG DS DIMONG KEC MADIUN

458123

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

7

1500000000777

PUSKESMAS GANTRUNG

JL RAYA DOLOPO DS SIDOREJO KEC.KEBONSARI

367743

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

8

1500000000778

PUSKESMAS GEGER

JL RAYA PONOROGO NO 48 DS PURWOREJO KEC GEGER

367158

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

9

1500000000794

PUSKESMAS GEMARANG

JL TGP NO 17 DS GEMARANG KEC GEMARANG

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

10

1500000000781

PUSKESMAS JETIS

JL JETIS DS JETIS KEC DAGANGAN

367664

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

11

1500000000782

PUSKESMAS JIWAN

JL RAYA SOLO NO 85 DS JIWAN KEC.JIWAN

465023

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

12

1500000000779

PUSKESMAS KAIBON

JL PANCOTARUNO NO 407 DS KAIBON KEC GEGER

455636

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

13

1500000000795

PUSKESMAS KARE

JL RAYA RANDU ALAS KARE KEC KARE

3406616

PER/16/05/2016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

14

1500000000776

PUSKESMAS KEBONSARI

JL UTERAN KEBONSARI NO 13 DS SINGGAHAN KEC KEBONSARI

367991

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

15

1500000000799

PUSKESMAS KLAGENSERUT

JL RAYA KLAGEN SERUT KEC JIWAN

499761

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

16

1500000000798

PUSKESMAS KLECOREJO

JL RAYA WATES DS KLECOREJO KEC MEJAYAN

388155

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

17

1500000000791

PUSKESMAS KREBET

JL GAWANG UTARA DS KREBET KEC.PILANGKENCENG

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

18

1500000000783

PUSKESMAS MADIUN

JL RAYA PUSKESMAS NO 9 DS TIRON KEC MADIUN

458271

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

19

1500000000936

PUSKESMAS MANGUHARJO

JL. GAJAHMADA NO. 124 KEL. MANGUHARJO KEC. MANGUHARJO

464661

PER/17/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

20

1500000000789

PUSKESMAS MEJAYAN

JL PANGLIMA SUDIRMAN NO 52 DS MEJAYAN KEC.MEJAYAN

384543

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

21

1500000000775

PUSKESMAS MLILIR

JL RAYA MADIUN PONOROGO NO 06 MLILIR KEC DLOPO

368098

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

22

1500000000797

PUSKESMAS MOJOPURNO

JL RAYA DUNGUS DS MOJOPURNO KEC WUNGU

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

23

1500000000934

PUSKESMAS ORO - ORO OMBO

JL. DIPONEGORO NO. 22 KEL. ORO-ORO OMBO KEC KARTOHARJO

464402

PER/17/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

24

1500000000937

PUSKESMAS PATIHAN

JL. MENDUT NO.1 KEL. PATIHAN KEC. MANGUHARJO

462272

PER/17/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

25

1500000000790

PUSKESMAS PILANG KENCENG

JL RAYA KENONGO REJO NO 774B DS KENONGOREJO KEC PILANGKENCENG

26

1500000000792

PUSKESMAS SARADAN

JL RAYA SARADAN DS SUGIHWARAS KEC SARADAN

27

1500000000785

PUSKESMAS SAWAHAN

JL RAYA KAJANG DS KAJANG KEC SAWAHAN

28

1500000000787

PUSKESMAS SIMO

29

1500000000793

30

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

PER/16/05/2016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

468434

PER/16/05/2016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

JL RAYA BALEREJO-MUNENG NO 96 DS SIMO KEC BALEREJO

661631

PER/16/05/2016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

PUSKESMAS SUMBERSARI

JL RAYA TULUNG NO 05 DS SUMBERSARI KEC SARADAN

384456

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

1500000000935

PUSKESMAS TAWANGREJO

JL. TAWANGSARI NO. 39 KEL. TAWANGREJO KEC. KARTOHARJO

483997

PER/17/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

31

1500000000788

PUSKESMAS WONOASRI

RAYA WONOASRI DS WONOASRI KEC WONOASRI

PER/16/052016

RS.TRAUMA CENTRE

13/05/2016

31/12/2017

32

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

33

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

34

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

35

7-3349569013

RSUD KOTA MADIUN

JL CAMPURSARI NO 12B

035148131 4

PEMERINTAH KOTA MADIUN

PER/08/032016

RS.TRAUMA CENTRE

13/05/2016

31/12/2016

KANTOR CABANG

MA11222I

:

383536

63151

N08- KANTOR CABANG BLITAR


SM0480



118 / 151 16-05-2016 07:59:01

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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

7-3033275153

KLINIK PRATAMA RAWAT INAP ABA HUSADA

JL RAYA KARANGAN KM 7

66361

035579583 1

DR. MOKH ROFIQ HINDIONO,MMRS

PER/07/042016

RS.TRAUMA CENTRE

25/04/2016

31/12/2017

2

1400000000148

RSU AMINAH BLITAR

JL VETERAN NO.39 KOTA BLITAR

66113

816304

YAY. RUMAH SAKIT AMINAH BLITAR

PER/09/052016

RS.TRAUMA CENTRE

02/05/2016

31/12/2017

3

07732

RSU AN-NISAA

JL.SUPARYONO NO.1 TALUN

692999

SRI MUNTAMAH

PER/05/042016

RS.TRAUMA CENTRE

01/04/2016

31/12/2017

4

7-1579046012

RSUD MARDI WALUYO

JL KALIMANTAN NO 113

66133

(0342)8011 18

PEMKOT BLITAR

PER/02/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

5

7-1575901783

RSUD NGUDI WALUYO WLINGI

JL DR SOECIPTO NO 5

66184

034269100 6

PEMKAB BLITAR

PER/01/012016

RS.TRAUMA CENTRE

25/01/2016

31/12/2016

KANTOR CABANG

NO

KODE PROVIDER

:

N09- KANTOR CABANG MADURA

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1400000000233

PUSKESMAS TLANAKAN

JL RAYA TLANAKAN PAMEKASAN

325568

PUSKESMAS

PER/01/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

2

1400000000437

RS LUKAS BANGKALAN

JL KH MOCH KHOLIL 36A BANGKALAN

3095148

PHILIP

PER/04/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

3

1400000000436

RSUD DR H MOH ANWAR SUMENEP

JL DR CIPTO NO 42 SUMENEP

662494

PER/03/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

4

1500000000235

RSUD SAMPANG

JL RAJAWALI NO 10

323956

PER/02/022016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I


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

NO

5

KODE PROVIDER

RSUD SYARIFAH AMBAMI RATO EBO BANGKALAN

1400000000520

KANTOR CABANG

NO

NAMA PROVIDER

:

KODE PROVIDER

ALAMAT

KODE POS

JL PEMUDA KAFFA NO. 9 BANGKALAN

IKS TELEPON

PIMPINAN NO IKS

3095088

PER/05/012016

TIPE IKS

AWAL IKS

RS.TRAUMA CENTRE

01/01/2016


N10- KANTOR CABANG BOJONEGORO

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1300000000045

RS DR. SUYUDI PACIRAN LAMONGAN

JL RAYA DEANDELES KECAMATAN PACIRAN

661412

DR DENNY AVIANTO SPD

PER/20/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

2

1300000000047

RS NAHDLATUL ULAMA (NU) TUBAN

JL LETDA SUCIPTO NO 211

328244

DR DIDIK SUHARSOYO MM MARS

PER/21/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

3

7-2471813999

RSUD NGIMBANG

JL. RAYA BABAT - JOMBANG NO. 227, SENDANGREJO, NGIMBANG LAMONGAN

DR. TAUFIK HIDAYAT

PER/1/012013

RS.TRAUMA CENTRE

11/03/2016

31/12/2016

4

1500000000747

RSUD. DR. KOESMA TUBAN

JL WAHIDIN SUDIRO HUSODO NO 800

321010

DR. H ZAINUL ARIFIN, SPPK

PER/03/042016

RS.TRAUMA CENTRE

01/05/2016

31/12/2017

5

1500000000517

RSUD.DR.SOEGIRI. LAMONGAN

JL. KUSUMA BANGSA NO.7

321718

DR. YULIARTO DWI MARTONO, MMKES

PER/4/042016

RS.TRAUMA CENTRE

06/04/2016

31/12/2017

KANTOR CABANG

NO

1

KODE PROVIDER

7-3207037624

MA11222I

:

62273

N11- KANTOR CABANG SIDOARJO

NAMA PROVIDER

KLINIK ASY SYIFA PPDFP

ALAMAT

JL RAYA BENDOMUNGAL SIDOREJO KRIAN

KODE POS

61214

IKS TELEPON

PIMPINAN NO IKS YAYASAN DALILUL FALIHIN PONPES DARUL FALAH PUSAT

PER/09/052016



AWAL IKS 09/05/2016


SM0480



120 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

2

1500000000172

KLINIK PRATAMA RAWAT JALAN & RAWAT INAP "BDS TEBEL" 24 JAM

JL TEBEL BARAT NO 1-3

3

1500000001401

PUSKESMAS BALONGBENDO

4

1500000001372

5

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

PER/01/022016

RS.TRAUMA CENTRE

18/04/2016

31/12/2016

JL MAYJEN BAMBANG SUWONO NO 11 SEDURI

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

PUSKESMAS BARENGKRAJAN

DS BARENGKRAJAN KEC KRIAN

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

1500000001363

PUSKESMAS BUDURAN

JL JAWA NO 2 KEC BUDURAN

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

6

1500000001354

PUSKESMAS CANDI

JL M RIDWAN NO 5 GELAM KEC CANDI

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

1500000001368

PUSKESMAS GANTING

JL SINGO MENGGOLO NO 1 DS GANTING

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

8

1500000001367

PUSKESMAS GEDANGAN

JL RAYA GEDANGAN 330 KEC GEDANGAN

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

9

1500000001352

PUSKESMAS JABON

JL DUKUH SARI KEC JABON

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

10

1500000001346

PUSKESMAS KEDUNG SOLO

DS KEDUNG SOLO KEC PORONG

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

11

1500000001356

PUSKESMAS KEPADANGAN

DS KEPADANGAN KEC TULANGAN

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

12

1500000001344

PUSKESMAS KREMBUNG

JL SUNGAI KAPUAS NO 2 KEC KREMBUNG

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

13

1500000001371

PUSKESMAS KRIAN

JL SETIA BUDI KEC KRIAN

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I

8911555


SM0480



121 / 151 16-05-2016 07:59:01

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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

14

1500000001366

PUSKESMAS MEDAENG

JL JOYOBOYO 40 MEDAENG KEC WARU

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

15

1500000001345

PUSKESMAS PORONG

JL JUWET UTARA 265 KEC PORONG

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

16

1500000001343

PUSKESMAS PRAMBON

JL RAYA PRAMBAON KEC PRAMBON

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

17

1500000001364

PUSKESMAS SEDATI

DS BETRO KEC SEDATI

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

18

1500000001361

PUSKESMAS SEKARDANGAN

JL WIJAYA KUSUMA NO 91 SEKARDANGAN

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

19

1500000001359

PUSKESMAS SIDOARJO

JL DR SOETOMO NO 14 KEC SIDOARJO

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

20

1500000001358

PUSKESMAS SUKODONO

DS PEKARUNGAN KEC SUKODONO

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

21

1500000001369

PUSKESMAS TAMAN

JL RAYA NGELOM 50 KEC TAMAN

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

22

1500000001353

PUSKESMAS TANGGULANGIN

JL RAYA PUTAT NO 38 KEC TANGGULANGIN

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

23

1500000001342

PUSKESMAS TARIK

JL RAYA KEMUNING KEC TARIK

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

24

1500000001370

PUSKESMAS TROSOBO

JL RAYA TROSOBO KEC TAMAN

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

25

1500000001355

PUSKESMAS TULANGAN

JL RAYA KEMANTREN KEC TULANGAN

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I


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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

26

1500000001360

PUSKESMAS URANGAGUNG

JL RAYA CEMENG KALANG KEC SIDOARJO

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

27

1500000001365

PUSKESMAS WARU

JL BARITO POJOK NO 1 WISTROP KEC WARU

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

28

1500000001357

PUSKESMAS WONOAYU

JL WONOAYU KEC WONOAYU

PER/26/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

29

1400000000128

RS BUNDA SIDOARJO

JL KUNDI NO 70 KEPUH KIRIMAN WARU

8668880

PER/25/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

30

0800000000036

RS CITRA MEDIKA

JL.RAYA SURABAYA-MOJOKERTO KM 44

361000

PER/21/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

31

1300000000030

RS SITI KHODIJAH

JL PAHLAWAN NO 260 SEPANJANG

7882123

YYS MUHAMMADIYAH

PER/23/12205

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

32

7-3200248883

RSIA ARAFAH ANWAR MEDIKA SUKODONO

JL SAWO NO 2 SUKODONO

031883098 9

DR ISKANDAR ALI

PER/08/052016

RS.TRAUMA CENTRE

09/05/2016

31/12/2016

33

1400000000278

RSU ANWAR MEDIKA

JL RAYA BY PASS KRIAN KM 33 BALONGBENDO

8974943

YAYASAN RUMAH SAKIT ANWAR MEDIKA

PER/22/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

34

1200000000014

RSU JASEM

JL KH SAMANHUDI NO 85

8962129

YAYASAN USADA KARYA

PER/24/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

35

0700000000008

RSUD SIDOARJO

JL MAJAPAHIT NO 667

8961649

PER/20/122015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

KANTOR CABANG

MA11222I

:

61258

PT PERMATA BUNDA BERSAMA

N12- KANTOR CABANG GRESIK


SM0480



123 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

1

1500000000811

BP PANGLIMA SUDIRMAN GRESIK

JL PANGLIMA SUDIRMAN

2

1500000001618

FKTP POLRES GRESIK

JL BASUKI RAHMAT 2 GRESIK

3

1500000000810

KLINIK HIDAYAH MANYAR

MANYAR RESORT

4

1400000000627

KLINIK KELUARGA BAHAGIA

5

1500000000893

6

KODE POS

IKS TELEPON

PIMPINAN NO IKS

AWAL IKS

AKHIR IKS

YUNI HIDAYATI

PER/12/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

DR. BUDIYONO, MARS

PER/14/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

085631864 35

YUNI HIDAYATI

PER/11/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

JL. RAYA WRINGINANOM KM.33.6

81180888

NOVEL MUHAMMAD RAMZY

PER/17/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

PUSKESMAS ALUN ALUN GRESIK

JL. PAHLAWAN GRESIK

3981865

DR. ACH SYAFI'I

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

1500000001569

PUSKESMAS BALONGPANGGANG GRESIK

RAYA KEDUNGPRING 8 BALONGPANGGANG GRESIK

7921007

DR RINI SULISTYOASIH

PER/05/012015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7

1500000001572

PUSKESMAS BENJENG GRESIK

JL. RAYA NYAYAT 34 BENJENG GRESIK

7921167

DR SONY

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

8

1500000001492

PUSKESMAS BUNGAH GRESIK

JL RAYA BUNGAH 15 GRESIK

3949600

DRG TITY KARYATI PANIGORO

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

9

1500000000757

PUSKESMAS CERME GRESIK

JL RAYA CERME KIDUL 52 CERME

7990007

DR LESTARI

PER/05/012015

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

10

1500000001573

PUSKESMAS DADAP KUNING GRESIK

JL. RAYA DADAP KUNING 32 GRESIK

7990510

DR GATOT PURNOMO

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

11

1500000001570

PUSKESMAS DAPET GRESIK

RAYA TANAH LENDEAN 49 BALONGPANGGANG GRESIK

70953980

DR SOESILO

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

12

1500000000741

PUSKESMAS DRIYOREJO GRESIK

RAYA DRIYOREJO GRESIK

23264794

DR DANIEL SA'U

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I

085631864 35

TIPE IKS


SM0480



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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

13

1500000001571

PUSKESMAS DUDUK SAMPEYAN GRESIK

RAYA DUDUK SAMPEYAN 45 DUDUK SAMPEYAN GRESIK

3903118

DRG NANIK LESTARI

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

14

1500000001489

PUSKESMAS DUKUN GRESIK

JL RAYA SEMBUNGAN KIDUL 37 DUKUN GRESIK

3949299

DRG SAIFUDIN GOZALI

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

15

1500000000742

PUSKESMAS GENDING GRESIK

JL VETERAN GRESIK

3985872

DRG HELENA SUZANA

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

16

1500000000892

PUSKESMAS INDUSTRI GRESIK

JL. ARIEF RAHMAN HAKIM 100 GRESIK

3985877

DRG ANISAH MAHMUDAH

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

17

1500000000890

PUSKESMAS KARANGANDONG GRESIK

RAYA KARANGANDONG DRIYOREJO GRESIK

7911659

DR SITI HAFIDA

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

18

1500000000894

PUSKESMAS KEBOMAS GRESIK

JL SUNAN GIRI III/1 GRESIK

3985880

DR. RAHAJU NUGRAHANI

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

19

1500000000755

PUSKESMAS KEDAMEAN GRESIK

RAYA KEDAMEAN NO 1 GRESIK

7911437

DR. HILDA BETSY

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

20

1500000001565

PUSKESMAS KEPATIHAN GRESIK

RAYA KEPATIHAN 151

7991403

DRG TITIEK SRI HAJATI

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

21

1500000001566

PUSKESMAS KESAMBEN KULON GREIK

KESAMBEN KULON WRINGINANOM GRESIK

60438431

SIDIK NURDIJANTO, SKM

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

22

1500000001617

PUSKESMAS MANYAR GRESIK

JL RAYA MANYAR 1 GRESIK

DRG JON SUDIRO

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

23

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

24

1500000001490

PUSKESMAS MENTARAS GRESIK

JL. RAYA MENTARAS DUKUN GRESIK

70954039

DR. RIZAUL FALAH

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I


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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

25

1500000001568

PUSKESMAS METATU GRESIK

JL. RAYA METATU 1 GRESIK

7991220

EKO HARIANTO, SKM

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

26

1500000001564

PUSKESMAS NELAYAN GRESIK

JL. GUB SURYO 33 GRESIK

3983036

DRG PEKIK PITA M

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

27

1500000001488

PUSKESMAS PANCENG GRESIK

JL RAYA PANCENG GRESIK

3940118

DR. JAIMAN

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

28

1500000001560

PUSKESMAS SEKAPUK GRESIK

JK RAYA DS SEKAPUK 15 UJUNG PANGKAH GRESIK

3948128

DR MUJTAHIDAH

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

29

1500000001563

PUSKESMAS SEMBAYAT GRESIK

JL. PENDOPO NO 1 SEMBAYAT GRESIK

3949800

DR TITIK ERNA

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

30

1500000001491

PUSKESMAS SIDAYU GRESIK

JL KANJENG PANGERAN 1 GRESIK

3949100

DR WIWIK SUSANTI

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

31

1500000001567

PUSKESMAS SLEMPIT GRESIK

RAYA SLEMPIT KEDAMEAN GRESIK

7911963

DR. SUKADI

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

32

1500000000175

PUSKESMAS SUKOMULYO

JL. KALIMANTAN NO.104 GKB GRESIK

3954818

DR LESTARI

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

33

1500000001562

PUSKESMAS UJUNG PANGKAH GRESIK

JL SITARDA 14 PANGKAH GRESIK

3944760

DR SETYORINI

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

34

1500000000889

PUSKESMAS WRINGINANOM GRESIK

RAYA WRINGINANOM 111 WRINGINANOM GRESIK

8975330

DR BUDI LUHUR

PER/05/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

35

1500000000808

RACHMIE CLINIC CERME

JL RAYA GURANGANYAR NO 23 CERME

331284499

DR. RAHMI ZUBAIDAH, SP.MK

PER/08/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

36

1500000000807

RACHMIE CLINIC DUDUK SAMPEYAN

RUKO D RAYA REGENCY R1 DUDUK SAMPEYAN GRESIK

331284499

DR RAHMI ZUBAIDAH, SP MK

PER/09/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

MA11222I


SM0480



126 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

3976688

DR.SINGGIH PRIYANTO, MARS

PER/02/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

7914025

RS RAMLI TARIGAN

PER/16/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

DR TITIN

PER/13/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

3981275

DR.MUSA GHUFRON

PER/04/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

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

RSUD IBNU SINA GRESIK

JL DR WAHIDIN SHD NO 243B

3951239

DR. ENDANG S, SP.THT

PER/01/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

SURYA GIRI JAYA CERME

JL. RAYA CERME GRESIK

63186435

YUNI HIDAYATI

PER/10/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

RS PETRO KIMIA GRESIK

JL JEND A YANI 69

39

1500000001993

RS SURYA MEDIKA GRESIK

LABAN KULON 58 MENGANTI

40

1500000001519

RS WATES HUSADA

RAYA BALONG PANGGANG GRESIK

41

1400000000364

RS.MUHAMMADIYAH GRESIK

JL.KH.KHOLIL NO.88

42

1400000000363

RSI DARUS SYIFA' BENOWO

43

0900000000002

44

1500000000809

MA11222I


0900000000039

1500000001442

AWAL IKS 01/01/2016

38

1


JL. PENDOPO 45 SEMBAYAT MANYAR

KODE PROVIDER

NO IKS PER/15/012016

RS FATHMA MEDIKA

NO

PIMPINAN

DR. ASLUCHUL ALIF

1500000001983

:

IKS TELEPON

3943500

37

KANTOR CABANG

KODE POS

61111

61174

N13- KANTOR CABANG SURABAYA DARMO

NAMA PROVIDER

BP ASHABUL KAHFI

ALAMAT

JL MERBABU BLOK A NO.05 KEPUH PERMAI

KODE POS

IKS TELEPON

PIMPINAN NO IKS

8666334

CV KEMBANG TANJUNG

PER/06/012016



AWAL IKS 20/01/2016


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KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

2

1500000001442

BP ASHABUL KAHFI


8666334

CV KEMBANG TANJUNG

PER/06/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

3

1500000001442

BP ASHABUL KAHFI


8666334

CV KEMBANG TANJUNG

PER/06/012016

RS.TRAUMA CENTRE

29/01/2016

31/12/2016

4

1500000001445

BP HIDAYAH WARU IV

JL GRAHA TIRTA RAYA I NO.28 WARU

70350252

CV KEMBANG TANJUNG

PER/07/012016

RS.TRAUMA CENTRE

01/02/2016

31/12/2016

5

1500000001445

BP HIDAYAH WARU IV


70350252

CV KEMBANG TANJUNG

PER/07/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

6

1500000001445

BP HIDAYAH WARU IV


70350252

CV KEMBANG TANJUNG

PER/07/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

7

1500000001444

BP KEBANGKITAN

JL MANUKAN MADYA 141 SURABAYA

71258886

CV KEMBANG TANJUNG

PER/08/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

8

1500000001444

BP KEBANGKITAN


71258886

CV KEMBANG TANJUNG

PER/08/012016

RS.TRAUMA CENTRE

01/02/2016

31/12/2016

9

1500000001444

BP KEBANGKITAN


71258886

CV KEMBANG TANJUNG

PER/08/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

10

1500000001443

BP KESAYANGAN

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

8700691

CV KEMBANG TANJUNG

PER/09/012016

RS.TRAUMA CENTRE

01/02/2016

31/12/2016

11

1500000001443

BP KESAYANGAN


8700691

CV KEMBANG TANJUNG

PER/09/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

12

1500000001443

BP KESAYANGAN


8700691

CV KEMBANG TANJUNG

PER/09/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

13

1500000001446

BP KESEJAHTERAAN

JL RUNGKUT MAPAN UTARA AA-17 SURABAYA

8706755

CV KEMBANG TANJUNG

PER/10/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

14

1500000001446

BP KESEJAHTERAAN


8706755

CV KEMBANG TANJUNG

PER/10/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

15

1500000001446

BP KESEJAHTERAAN


8706755

CV KEMBANG TANJUNG

PER/10/012016

RS.TRAUMA CENTRE

01/02/2016

31/12/2016

16

1500000001335

KLINIK CITRA MEDICAL CENTRE

JL KETINTANG BARU III/56 SURABAYA

8291214

DR SAID MOHAMMAD T

PER/15/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

17

1500000001393

KLINIK KARYA MEDIKA 104

JL BANYU URIP NO 302 SURABAYA

5324326

CV KARYA MEDIKA

PER/16/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

18

1500000001393



5324326

CV KARYA MEDIKA

PER/16/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

19

1500000001393



5324326

CV KARYA MEDIKA

PER/16/012016

RS.TRAUMA CENTRE

01/02/2016

31/12/2016

20

1500000001394


BUKIT CITRA DARMO BLOK BC C30/JL KLAKAH REJO I-20 SURABAYA

CV KARYA MEDIKA

PER/17/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

21

1500000001394



CV KARYA MEDIKA

PER/17/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

22

1500000001394



CV KARYA MEDIKA

PER/17/012016

RS.TRAUMA CENTRE

01/02/2016

31/12/2016

23

1500000001395


JL NGAGLIK NO 47 SURABAYA

3764782

CV KARYA MEDIKA

PER/18/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

24

1500000001395



3764782

CV KARYA MEDIKA

PER/18/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

25

1500000001395



3764782

CV KARYA MEDIKA

PER/18/012016

RS.TRAUMA CENTRE

01/02/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

26

1500000001379

KLINIK SARTIKA 36

BRATANG BINANGUN GANG VI/47 SURABAYA

34417343

DR LILIK SRI HARTINI

PER/11/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

27

1500000001379

KLINIK SARTIKA 36


34417343


PER/11/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

28

1500000001379

KLINIK SARTIKA 36


34417343


PER/11/012016

RS.TRAUMA CENTRE

01/02/2016

31/12/2016

29

1500000001377

KLINIK SARTIKA 44

JL RAYA MASTRIP NO 32 KARANG PILANG SURABAYA

34200705


PER/12/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

30

1500000001377

KLINIK SARTIKA 44


34200705


PER/12/012016

RS.TRAUMA CENTRE

01/02/2016

31/12/2016

31

1500000001377

KLINIK SARTIKA 44


34200705


PER/12/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

32

1500000001376

KLINIK SARTIKA 59

JL MANUKAN TENGAH 9K/10 SURABAYA

34183507


PER/13/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

33

1500000001317

KLINIK SARTIKA 77

JL TRUNOJOYO NO 2 SEPANJANG

7871549


PER/14/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

34

1500000001373

POLIKLINIK PUTRI RAHAYU

JL MASTRIP IX/9 WARUGUNUNG KARANGPILANG

7667983

BILAL ZAENAL ABIDIN

PER/05/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

35

1500000001373



7667983

BILAL ZAENAL ABIDIN

PER/05/012016

RS.TRAUMA CENTRE

29/01/2016

31/12/2016

36

1500000001373



7667983

BILAL ZAENAL ABIDIN

PER/05/012016

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

37

1100000000018

RS BHAKTI RAHAYU (TC)

JL KETINTANG MADYA I / 6 SURABAYA

8289668

PT BHAKTI RAHAYU

PER/03/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

MA11222I


SM0480



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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

38

1100000000008

RS BUNDA SURABAYA

JL RAYA KANDANGAN 23-24

7440077

PT PERMATA BUNDA BERSAMA

PER/02/012015

RS.TRAUMA CENTRE

04/01/2016

31/12/2016

39

0900000000003

RS MUJI RAHAYU

JL RY MANUKAN WETAN 68-68A SURABAYA

7404132

YAYASAN MUJI RAHAYU

PER/01/012016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

40

1400000000385

RS WIYUNG SEJAHTERA

JL KARANGAN PDAM NO 1-3 WIYUNG SURABAYA

7532653

PT WIYUNG SEJAHTERA

PER/04/012016

RS.TRAUMA CENTRE

07/01/2016

31/12/2016

KANTOR CABANG

NO

:

KODE PROVIDER

N14- KANTOR CABANG SURABAYA TANJUNG PERAK

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1400000000517

KLINIK WISMA HUSADA

JL DUKUH SETRO 7A KAV NO 2

PER/ 01/ 01-2016

RS.TRAUMA CENTRE

01/01/2016

31/12/2016

2

1400000000517

KLINIK WISMA HUSADA

JL DUKUH SETRO 7A KAV NO 2

PER/ 01/ 012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

3

0700000000012

RS AL-IRSYAD

JL KHM MANSUR 210-214 SURABAYA

3531223

DR AHMAD BAKARMAN, MARS

PER/ 02/012016

RS.TRAUMA CENTRE

13/01/2016

31/10/2016

4

0700000000012

RS AL-IRSYAD

JL KHM MANSUR 210-214 SURABAYA

3531223

DR AHMAD BAKARMAN, MARS

PER/ 02/012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

5

1400000000469

RUMAH SAKIT PRIMASATYA HUSADA CITRA

JL. PRAPAT KURUNG SELATAN NO. 1

3294801

PT RUMAH SAKIT PRIMASATYA HUSADA CITRA

PER/ 03/ 012016

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

KANTOR CABANG

MA11222I

:

N15- KANTOR CABANG SURABAYA RUNGKUT


SM0480



131 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

1

7-3127077493

RS ANGKATAN LAUT DR. RAMELAN SURABAYA

JL. GADUNG NO. 1 SURABAYA

60238

2

1100000000022

RS ISLAM SURABAYA JEMURSARI

JL JEMURSARI 51-57

60236

KANTOR CABANG

NO

:

KODE PROVIDER

IKS TELEPON

PIMPINAN NO IKS

847187778

TIPE IKS

AWAL IKS

AKHIR IKS

RSAL DR RAMELAN SURABAYA

PER/01/042016

RS.TRAUMA CENTRE

01/05/2016

31/12/2017

YAYASAN RS ISLAM SURABAYA

PER/01/082015

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

P00- KANTOR CABANG PONTIANAK

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR 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

1400000000373

RS 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

1400000000383

RSUD KABUPATEN SANGGAU

JL JENDRAL SUDIRMAN

78511

21070

DR. H. EDY SUPRABOWO, MKM

PER/02/012016

RS.TRAUMA CENTRE

24/02/2016

31/12/2016

4

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

5

1400000000464

RUMAH SAKIT UMUM BETHESDA SERUKAM

JL. RAYA SINGKAWANG-BENGKAYANG KM 48

79281

637019

DR. EDY ARISTON LUBIS, SPM., M.SC

PER/11/022016

RS.TRAUMA CENTRE

24/02/2016

31/01/2017

6

7-2877295653

RUMAH SAKIT UMUM PARINDU

DUSUN DOHIK EMPANING DESA BINJAI

78562

DR. HENDRA HADIYANTA

PER/15/042016

RS.TRAUMA CENTRE

11/04/2016

31/03/2017

KANTOR CABANG

MA11222I

:

R00- KANTOR CABANG BANJARMASIN


SM0480



132 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

1

7-2797750137

RSJ SAMBANG LIHUM BANJARMASIN

JL. GUBENRNUR SYARKAWI KM 3,9 GAMBUT KAB. BANJAR

00000

2

7-2464169583

RSUD ULIN BANJARMASIN

JL. A. YANI NO.43 BANJARMASIN

70233

KANTOR CABANG

NO

1

KODE PROVIDER

RUMAH SAKIT UMUM DAERAH KOTABARU

KODE PROVIDER

:

ALAMAT

KODE POS

JL.H.HASAN BASRI NO.57

NO IKS

33257472

TIPE IKS

AWAL IKS

AKHIR IKS

H.IBG DHARMA PUTRA

PER/03/032016

RS.TRAUMA CENTRE

11/04/2016

17/03/2017

DR. HJ. SUCIATI M. KES

PER/02/032016

RS.TRAUMA CENTRE

10/03/2016

02/03/2017

IKS TELEPON

PIMPINAN NO IKS

22945

PER/01/012016

TIPE IKS

AWAL IKS

RS.TRAUMA CENTRE

01/01/2016


R03- KANTOR CABANG PALANGKARAYA

NAMA PROVIDER

ALAMAT

1

7-2907310053

RSUD DR DORIS SYLVANUS

JL TAMBUN BUNGAI NO 04

2

1300000000039

RSUD DR SOEMARNO SOSROADMODJO

JL TAMBUN BUNGAI NO 16 KAPUAS

3

1300000000046

RUMAH SAKIT BHAYANGKARA TK IV

JL JENDERAL A YANI NO 22

4

7-2201647033

UPT PUSKESMAS TANGKILING PALANGKARAYA

JL TJILIK RIWUT KM 34 KEL TANGKILING KEC BUKIT BATU

MA11222I

PIMPINAN

R02- KANTOR CABANG KOTABARU

NAMA PROVIDER

1500000000845

KANTOR CABANG

NO

:

IKS TELEPON

KODE POS

IKS TELEPON

NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

PEMERINTAH DAERAH

PER / 11 /022016

RS.TRAUMA CENTRE

13/04/2016

26/02/2017

23791

PEMKAB KAPUAS

PER/13/062015

RS.TRAUMA CENTRE

02/03/2016

04/06/2017

3281553

POLDA KAL TENG

PER/13/032016

RS.TRAUMA CENTRE

13/04/2016

28/02/2017

UPT PUSKESMAS TANGKILING

PER/04/012016

RS.TRAUMA CENTRE

24/02/2016

22/07/2016

73111

73221

PIMPINAN


SM0480



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NO

:

KODE PROVIDER

R04- KANTOR CABANG PANGKALAN BUN

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

7-1706946523

PUSKESMAS KUMAI

JL PEMUDA KECAMATAN KUMAI

74181

DR ABIMAYU

PER/03/012016

RS.TRAUMA CENTRE

29/01/2016

18/01/2017

2

7-1702557673

PUSKESMAS SEMANGGANG

JL A YANI KM 60 SEMANGGANG KEC PANGKALAN BANTENG

74183

DR JHONFERI SIDABALOK

PER/02/012016

RS.TRAUMA CENTRE

29/01/2016

18/01/2017

KANTOR CABANG

NO

KODE PROVIDER

:

S00- KANTOR CABANG BALIKPAPAN

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000552

POLIKLINIK IBNU SINA BALIKPAPAN

JL.JEND.A.YANI NO.252 KEL.MUARA RAPAK

7091900

DR.HADI YUNIARKO

PER/16/042016

RS.TRAUMA CENTRE

26/04/2016

31/03/2017

2

1400000000064

RS BALIKPAPAN BARU

JL MT HARYONO KOMPLEK BALIKPAPAN BARU BLOK A3 A NO 7-9 KALTIM

877330

DR M DANARTO, M MED

PER/09/04/2016

RS.TRAUMA CENTRE

26/04/2016

28/02/2017

3

7-3289201063

RSUD DR.KANUJOSO DJATIWIBOWO BALIKPAPAN

JL.MT.HARYONO NO.656, BALIKPAPAN

DR.EDY ISKANDAR,SP.PD.,FINASI M.,MARS

PER/18/052016

RS.TRAUMA CENTRE

13/05/2016

01/05/2017

4

1500000000729

RSUD KOTA BALIKPAPAN

JL.MAYJEND SUTOYO RT.01 KEL.GUNUNG SARI ULU KEC.BALIKPAPAN TENGAH

DRG.DYAH MURYANI

PER/13/042016

RS.TRAUMA CENTRE

11/05/2016

31/03/2017

5

1500000000184

RSUD PENAJAM PASER UTARA

JL.PROPINSI KM.09 PENAJAM PASER UTARA KALTIM

7211361

DR.JANSJE GRACE MAKISURAT

PER/15/042016

RS.TRAUMA CENTRE

11/05/2016

05/02/2017

6

1500000000188

RUMAH SAKIT BHAYANGKARA BALIKPAPAN

JL.JEND.SUDIRMAN NO.14 BALIKPAPAN

421261

DR.WILDAN DJAYA SOEKMARA,SP.B,FINACS

PER/12/042016

RS.TRAUMA CENTRE

11/05/2016

28/02/2017

MA11222I

76125


SM0480



134 / 151 16-05-2016 07:59:01


NO

KODE PROVIDER

:

S01- KANTOR CABANG SAMARINDA

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

7-1380214421

PUKESMAS BANTUAS

JL BANTUAS PALARAN

75241

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

2

7-1464240699

PUSKESMAS AIR PUTIH

JL AIR PUTIH SAMARINDA ULU

75122

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

24/02/2016

31/12/2016

3

7-1464311570

PUSKESMAS BAQA

JL BAQA SAMARINDA SEBERANG

75131

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

4

7-1356917662

PUSKESMAS BENGKURING

BENGKURING

75118

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

5

7-1380408843

PUSKESMAS BUKUAN

JL BUKUAN PALARAN

75241

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

6

7-1464600433

PUSKESMAS HARAPAN BARU

JL HARAPAN BARU SAMARINDA SEBERANG

75131

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

7

7-1359826423

PUSKESMAS JUANDA

JL IR JUANDA SAMARINDA ULU

75122

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

8

7-1507208803

PUSKESMAS KARANG ASAM SAMARINDA

JL KARANG ASAM

75125

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

9

7-1464440551

PUSKESMAS LEMPAKE

JL LEMPAKE SAMARINDA UTARA

75118

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

10

7-1466746238

PUSKESMAS LOA BAKUNG

JL LOA BAKUNG SUNGAI KUNJANG

75125

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

11

7-1380502014

PUSKESMAS MAKROMAN

JL MAKROMAN PALARAN

75241

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

12

7-1464657234

PUSKESMAS MANGKUPALAS

JL MANGKUPALAS SAMARINDA SEBERANG

75131

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

MA11222I


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

13

7-1464111057

PUSKESMAS PALARAN

JL PALARAN

75241

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

14

7-1380304232

PUSKESMAS PASUNDAN

JL PASUNDAN KEL JAWA SAMARINDA ULU

75122

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

15

7-1463967676

PUSKESMAS REMAJA

JL REMAJA SUNGAI PINANG

75117

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

16

7-1464167298

PUSKESMAS SAMBUTAN

JL SAMBUTAN

75114

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

17

7-1461318105

PUSKESMAS SEGIRI

JL SEGIRI SAMARINDA KOT

75111

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

18

7-1380543865

PUSKESMAS SEMPAJA

SEMPAJA SAMARINDA UTARA

75118

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

19

7-1465607297

PUSKESMAS SIDOMULYO

JL SIDOMULYO SAMARINDA ILIR

75114

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

20

7-1464546252

PUSKESMAS SUNGAI KAPIH

JL SUNGAI KAPIH SAMBUTAN

75114

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

20/01/2016

31/12/2016

21

7-1378835889

PUSKESMAS SUNGAI SIRING

KELURAHAN SUNGAI SIRING SAMARINDA

75118

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

22

7-1380635626

PUSKESMAS TEMINDUNG

JL TEMINDUNG SAMARINDA UTARA

75118

PEMERINTAH

PKS/02/12.2015

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

23

1500000000941

PUSKESMAS TRAUMA CENTRE

JL CIPTO MANGUNKUSUMO KEL SENGKOTEK KEC LOA JANAN ILIR

PKS/02/12.2015

RS.TRAUMA CENTRE

11/04/2016

31/12/2016

24

7-1380777307

PUSKESMAS WONOREJO

KELURAHAN WONOREJO

PKS/02/12.2015

RS.TRAUMA CENTRE

12/01/2016

31/12/2016

MA11222I

75125

PEMERINTAH


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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

25

1400000000160

RS. ISLAM SAMARINDA

JL. GURAMI NO.18

26

7-3057671463

RSJD ATMA HUSADA MAHAKAM

JL KAKAP NO 23 KOTA SAMARINDA

27

1500000000320

RSUD ABDUL WAHAB SJAHRANI

JL PMI KOTA SAMARINDA

28

1400000000413

RSUD HARAPAN INSAN SENDAWAR

JL MAWAR KEC. SEKOLAQ DARAT

29

7-1356184197

RSUD I.A MOEIS

JL H.A M.M RIFADDIN

KANTOR CABANG

NO

1

KODE PROVIDER

1

BLUD RSD. DR. SOEMARNO SOSROADMODJO BULUNGAN

KODE PROVIDER

7-1506142935

MA11222I

:

IKS TELEPON

PIMPINAN NO IKS

741510

75114

AWAL IKS

AKHIR IKS

DR. SYAFARDI IBRAHIM

PKS/01/052015

RS.TRAUMA CENTRE

11/04/2016

30/04/2016

PEMERINTAH

PKS/01/042016

RS.TRAUMA CENTRE

25/04/2016

31/03/2017

PKS/01/032016

RS.TRAUMA CENTRE

18/03/2016

31/12/2016

PKS/01/112015

RS.TRAUMA CENTRE

11/04/2016

31/10/2016

PKS/01/12.2015

RS.TRAUMA CENTRE

11/01/2016

31/12/2016

4044001

75131

TIPE IKS

PEMERINTAH

S02- KANTOR CABANG TARAKAN

NAMA PROVIDER

1300000000043

KANTOR CABANG

NO

:

KODE POS

ALAMAT

KODE POS

JL. CENDRAWASIH TANJUNG SELOR

IKS TELEPON

PIMPINAN NO IKS

21292

PEMKAB BULUNGAN

PER/03/022016

TIPE IKS

AWAL IKS

RS.TRAUMA CENTRE

10/03/2016


S04- KANTOR CABANG BERAU

NAMA PROVIDER

PUSKESMAS GUNUNG TABUR

ALAMAT

JL. BANGSAWAN RT 02 GUNUNG TABUR KAB. BERAU

KODE POS

77352

IKS TELEPON

PIMPINAN NO IKS DINAS KESEHATAN KABUPATEN BERAU

PER/06/122015



AWAL IKS 20/01/2016


SM0480



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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

2

7-1507943081


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


PER/06/122015

RS.TRAUMA CENTRE

20/01/2016

01/12/2016

4

7-1506142933

PUSKESMAS TELUK BAYUR

JL. KANDANG MUNTIK, KEL. TELUK BAYUR KAB. BERAU

77315


PER/06/122015

RS.TRAUMA CENTRE

20/01/2016

01/12/2016

KANTOR CABANG

NO

KODE PROVIDER

:

T00- KANTOR CABANG MANADO

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1400000000069

DR. FRANS PALILIEWU

JLN. SUTOYO NO. 106 KOTAMOBAGU

21192

DR. FRANS PALILIEWU

PER/011/032016

RS.TRAUMA CENTRE

31/03/2016

31/12/2017

2

1400000000070

PRAKTEK DR RAUW GEERTJE ADELEIDA

JL TNI 4 NO 53 TIKALA ARES LINGK II MANADO

3357822

DR RAUW G ADELEIDA

PER/008/032016

RS.TRAUMA CENTRE

01/03/2016

31/12/2017

3

02412

RS BUDI MULIA BITUNG

JL YOS SUDARSO BITUNG

21332

DR. JOHANNIS ANDRIES NAJOAN MKES. SPFK.DK

PER/22/10/2015

RS.TRAUMA CENTRE

28/01/2016

31/12/2017

4

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

5

1400000000068

RS ROBERT WOLTER MONGISIDI

JLN. 14 FEBRUARI TELING ATAS

876087

DR. ADHY SUGIH ARTO

PER/007/03/2016

RS.TRAUMA CENTRE

01/03/2016

31/12/2017

6

1400000000067

RS SITTI MARYAM

JLN. POGIDON RAYA NO. 110 KEC. TUMINTING

851577

DR. ANY RACHMAN

PER/005/032016

RS.TRAUMA CENTRE

01/03/2016

31/12/2017

MA11222I


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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

7

1400000000078

RSU PANCARAN KASIH GMIM MANADO

JL SAM RATULANGI XIII MANADO

8

7-2330823833

RSUP PROF DR R D KANDOU

JL RAYA TANAWANGKO NO 56

9

1500000000352

RUMAH SAKIT BHAYANGKARA MANADO

10

1500000000085

11

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

DR FRANKY V T KAMBEY

PER/004/032016

RS.TRAUMA CENTRE

01/03/2016

31/12/2017

DR. MAXI R. RONDONUWU, DHSM, MARS

PER/002/032016

RS.TRAUMA CENTRE

02/03/2016

31/12/2017

JALAN SAM RATULANGI NO. 326 MANADO

DRG. IGNATIUS HENDRA ARIFIANTO

PER/009/032016

RS.TRAUMA CENTRE

01/03/2016

31/12/2017

RUMAH SAKIT BUDI MULIA BITUNG

JL. SAM RATULANGI X/9A BITUNG

LUCI

PER/022/10/2015

RS.TRAUMA CENTRE

28/01/2016

31/12/2017

1400000000232

RUMAH SAKIT UMUM BETHESDA

JALAN RAYA TOMOHON, KOTA TOMOHON

891020

DR ROBBIN R.F WAROUW

PER/003/072016

RS.TRAUMA CENTRE

01/03/2016

31/12/2017

12

1400000000153

RUMAH SAKIT UMUM HERMANA LEMBEAN

JLN. A. MONONUTU DESA LEMBEAN, MINAHASA UTARA

891020

DR. LAURENTIUS RONALD PONTOH

PER/006/032016

RS.TRAUMA CENTRE

01/03/2016

31/12/2017

13

1400000000059

RUMKITAL DR. WAHYU SLAMET

JALAN YOS SUDARSO NO. 26 BITUNG

35030

DR. SUJOKO PURNOMO, SP.B

PER/001/022016

RS.TRAUMA CENTRE

01/03/2016

31/12/2017

14

1400000000428

SILOAM INTERNATIONAL HOSPITAL MANADO

JLN. SILOAM NO. 6 LIPPO VILLAGE TANGERANG

DR. ANDRY, M.M M.H.KES

PER/23/112015

RS.TRAUMA CENTRE

28/01/2016

31/12/2017

KANTOR CABANG

NO

1

KODE PROVIDER

1500000000952

MA11222I

:

857629

95115

T01- KANTOR CABANG PALU

NAMA PROVIDER

POLIKLINIK PT. HARDAYA INTI PLANTATIONS

ALAMAT

PT. HARDAYA INTI PLANTATIONS

KODE POS

IKS TELEPON

PIMPINAN NO IKS

3149088

IR. YANI ANSHORI

PER/005/022016



AWAL IKS 01/05/2016


SM0480



139 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

2

1400000000290

PUSKESMAS SALAKAN

SALAKAN KABUPATEN BANGGAI KEPULAUAN

3

7-2728692225

RS. BUDI AGUNG

JL. MALUKU NO. 44 KOTA PALU

94231

4

1400000000054

RSD. MADANI

JL.THALUA KONCHI NO.11 MAMBORO

94111

5

1400000000081

RSU LUWUK

JL. IMAM BONJOL NO. 14 LUWUK

6

1400000000083

RSU. ANUTAPURA

JL. KANGKUNG NO. 01 PALU

7

1400000000231

RSUD KABELOTA

JL. TRANS SULAWESI KAB. DONGGALA

8

1500000000735

RSUD TORA BELO

JL. POROS PALU-PALOLO DESA SIDERA

KANTOR CABANG

NO

KODE PROVIDER

:

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

DR. JAMES HD PINONTOAN

PER/16/082015

RS.TRAUMA CENTRE

14/01/2016

31/07/2016

0451421360

DR. IDA BAGUS YADNYA PUTRA

PER/013/032016

RS.TRAUMA CENTRE

01/04/2016

31/05/2018

491470

DR. ISHARWATI M.KES

PER/002/012016

RS.TRAUMA CENTRE

01/03/2016

28/02/2017

21820

DR. YUSRAN KASIM ME

PER/003/012016

RS.TRAUMA CENTRE

27/04/2016

31/03/2018

462770

DR. FARIDA H. INGOLO, M.KES

PER/001/012016

RS.TRAUMA CENTRE

18/03/2016

28/02/2018

DRG. AMRIANI LAPASE

PER/010/032016

RS.TRAUMA CENTRE

01/06/2016

31/05/2018

DRG. HARI SETIYONO

PER/007/022016

RS.TRAUMA CENTRE

01/05/2016

30/04/2018

94364

T02- KANTOR CABANG GORONTALO

NAMA PROVIDER

ALAMAT

1

1400000000156

KWANDANG MEDICAL CENTER

JL TRANS SULAWESI DESA MOLUO KEC KWANDANG

2

1500000000879

PUSKESAMAS ASPARAGA

DESA BULULI KEC ASPARAGA KAB GORONTALO

MA11222I

94111

IKS TELEPON

KODE POS

IKS TELEPON

PIMPINAN NO IKS

DINAS KESEHATAN KABUPATEN GORONTALO

TIPE IKS

AWAL IKS

AKHIR IKS

PER/11/042016

RS.TRAUMA CENTRE

09/05/2016

17/04/2018

PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018


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140 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

3

1500000000908

PUSKESMAS BATUDAA

DESA PANYUNGA KEC BATUDAA


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

4

1500000000886

PUSKESMAS BATUDAA PANTAI

JL TRANS SULAWESI KM 38 DESA KAYUBULAN KEC BATUDAA PANTAI KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

5

1500000000877

PUSKESMAS BILATO

DESA BILATO KEC BOLIYOHUTO KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

6

1500000000906

PUSKESMAS BILUHU

DESA LOBUTO KEC BILUHU KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

7

1500000000883

PUSKESMAS BOLIYOHUTO

DESA SIDOMULYO KEC BOLIYOHUTO KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

8

1500000000880

PUSKESMAS BUHU

DESA BUHU KEC TIBAWA KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

9

1500000000884

PUSKESMAS DUNGALIYO

DESA KALIYOSO KEC BONGOMEME KAB GORONTALO

DINAS KESEHATAN KAB GORONTALO

PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

10

1500000000864

PUSKESMAS LIMBOTO

JL TILONGKABILA KEL HEPUHULAWA KEC LIMBOTO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

11

1500000000870

PUSKESMAS LIMBOTO BARAT

JL TRANS SULAWESI DESA YOSONEGORO KEC LIMBOTO BARAT


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

30/04/2018

12

1500000000881

PUSKESMAS MOLOPATODU

DESA MOLOPATODU KEC BONGOMEME KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

13

1500000000875

PUSKESMAS MOOTILANGO

DESA PARIS KEC MOOTILANGO KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

14

1500000000876

PUSKESMAS PILOHAYANGA

DESA DULOHUPA KEC TELAGA KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

MA11222I

96211


SM0480



141 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

15

1500000000878

PUSKESMAS PULUBALA

DESA PONGONGAILA KEC PULUBALA KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

16

1500000000885

PUSKESMAS TABONGO

DESA TABONGO BARAT KEC TABONGO KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

17

1500000000910

PUSKESMAS TELAGA

JALAN LIMBOTO RAYA DESA MONGOLATO KEC TELAGA


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

18

1500000000905

PUSKESMAS TELAGA BIRU

JL LIMBOTO RAYA DESA TULADENGGI KEC TELAGA BIRU


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

19

1500000000907

PUSKESMAS TELAGA JAYA

DESA HUTADAA KEC TELAGA JAYA KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

20

1500000000904

PUSKESMAS TIBAWA

DESA ISIMU SELATAN KEC TIBAWA KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

21

1500000000909

PUSKESMAS TILANGO

DESA TILOTE KEC TILANGO KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

22

1500000000874

PUSKESMAS TOLANGOHULA

DESA SUKA MAKMUR KEC TOLANGOHULA KAB GORONTALO


PER/09/042016

RS.TRAUMA CENTRE

01/05/2016

31/03/2018

23

1400000000104

RSUD M.M.DUNDA

JLN ACHMAD A. WAHAB NO 53 KEC LIMBOTO

RSUD DR M.M DUNDA

PER/01/012016

RS.TRAUMA CENTRE

10/02/2016

31/12/2017

24

1400000000477

RSUD OTANAHA

JL RAMBUTAN NO 413 KEL BULADU KEC KOTA BARAT

RSUD OTANAHA

PER/02/012016

RS.TRAUMA CENTRE

01/03/2016

31/12/2017

25

1400000000102

RSUD PROF DR. H. ALOEI SABOE

JL PROF DR H ALOEI SABOE KEL WONGKADITI TIMUR

RSUD PROF DR. H. ALOEI SABOE

PER/04/042015

RS.TRAUMA CENTRE

10/02/2016

31/12/2016

26

1400000000155

RSUD TOTO KABILA

JL KESEHATAN NO 25 DESA PERMATA KEC TILONGKABILA

RSUD TOTO KABILA

PER/05/012016

RS.TRAUMA CENTRE

10/02/2016

31/12/2017

MA11222I

881455

8701943


SM0480



142 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

27

1400000000157

RSUD ZAINAL UMAR SIDIKI

DESA BULALO KEC KWANDANG KAB GORUT

96252

28

1500000001830

RUMAH SAKIT ISLAM GORONTALO

JL PROF DR HB JASSIN NO 457 KOTA GORONTALO

96128

29

1400000000472

RUMAH SAKIT UMUM BUNDA

JL PROF DR HB JASSIN KEL WUMIALO KEC KOTA TENGAH

KANTOR CABANG

NO

KODE PROVIDER

:

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

RSUD ZAINAL UMAR SIDIKI

PER/10/042016

RS.TRAUMA CENTRE

20/04/2016

31/03/2018

830820

YAYASAN KESEJAHTERAAN UMAT HASANAH GORONTALO

PER/07/082016

RS.TRAUMA CENTRE

01/05/2016

21/03/2018

829290

DANIEL RANTI

PER/03/012016

RS.TRAUMA CENTRE

04/04/2016

03/01/2018

W00- KANTOR CABANG MAKASSAR

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000032

BALAI LATIHAN KERJA INDUSTRI MAKASSAR

JL.TAMAN MAKAM PAHLAWAN NO 4

PER/012/012016

RS.TRAUMA CENTRE

16/03/2016

07/01/2018

2

1500000000032

BALAI LATIHAN KERJA INDUSTRI MAKASSAR

JL.TAMAN MAKAM PAHLAWAN NO 4

PER/012/012016

RS.TRAUMA CENTRE

14/03/2016

07/01/2018

3

1500000000027

BALAI LATIHAN KERJA KOTAMADYA PARE PARE

JL BAU MASSEPE, PARE-PARE

23046

PER/019/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

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

PER/009/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

6

1400000000117

HEALTH AND NUTRITION CLINIC

JL PERINTIS KEMERDEKAAN KM 8 KOMP RUKO ANTARA NO 25

581983

PROF.DR.DR.HJ.SURYANI AS'AD M,SC,SP.GK

PER/009/012016

RS.TRAUMA CENTRE

16/03/2016

04/01/2018

MA11222I


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143 / 151 16-05-2016 07:59:01

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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

7

7-2377521926

KLINIK IMEDICAL SPECIALIST CENTRE

JL. RACING CENTRE NO 17/39 MAKASSAR

8

1400000000075

KLINIK SEROJA

JL. GOA RIA NO. 106 SUDIANG

9

1400000000075

KLINIK SEROJA

10

1400000000161

11

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

DR.DR.MASYITA GAFFAR, SP.THT-KL

PER/001/012016

RS.TRAUMA CENTRE

07/03/2016

04/01/2018

550228

DR. MOH. HELMY JUSUF

PER/008/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

JL. GOA RIA NO. 106 SUDIANG

550228

DR. MOH. HELMY JUSUF

PER/008/012016

RS.TRAUMA CENTRE

16/03/2016

04/01/2018

PUSKESMAS BUNGORO

KECAMATAN BUNGORO KAB PANGKEP

4291557

DRG ANWAR NUHUNG

PER/016/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

1400000000161

PUSKESMAS BUNGORO

KECAMATAN BUNGORO KAB PANGKEP

4291557

DRG ANWAR NUHUNG

PER/016/012016

RS.TRAUMA CENTRE

16/03/2016

04/01/2018

12

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

13

1400000000044

RS AWAL BROS MAKASSAR

JL. JENDRAL URIP SUMOHARJO NO. 43

454567

PER/006/012016

RS.TRAUMA CENTRE

24/02/2016

31/12/2017

14

1500000000108

RS DR M YASIN BONE

JL JENDRAL SUDIRMAN WATAMPONE BONE

PER/025/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

15

1400000000046

RS ISLAM FAISAL MAKASSAR

JALAN ANDI PANGERAN PETTARANI MAKASSAR

871942

PER/004/012016

RS.TRAUMA CENTRE

07/03/2016

04/01/2018

16

1500000000333

RSU HIKMAH

JL YOSEF LATUMAHINA NO 1

872284

PER/014/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

17

1500000000028

RSU LASINRANG PINRANG

JL MACAN NO 9 KABUPATEN PINRANG

921118

PER/020/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

18

1400000000190

RSUD ANDI MAKASSAU

JL NURUSSAMAWATI NO 9 PAREPARE

21163

PER/23/012015

RS.TRAUMA CENTRE

18/03/2016

04/05/2017

MA11222I

90231

PT MAKASSAR GLOBAL AWAL BROS

PROF DR H SYAFRUDDIN WAHID PHD,SP,PA(K)

II.DR. H. KAMARUDDIN SAID, SP.B, MARS


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KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

PER/018/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

PER/024/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

PER/013/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

PER/021/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

JALAN POROS BALAMBANG KEL. MINAKE KEC. TANDUKKALUA' KAB. MAMASA

PER/005/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

RSUD LAMADUKELLENG SENGKANG WAJO

JL KARTIKA CANDRA KIRANA SENGKANG

PER/027/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

1400000000173

RSUD LANTO DAENG PASEWANG

JL LINGKAR KARISA BONTOSUNGGU NO

PER/022/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

26

1400000000195

RSUD LATEMMAMALA

JL MALAKA RAYA WATANSOPPENG

PER/026/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

27

1500000000109

RSUD MAJENE

JALAN POROS MAJENE MAMUJU

PER/029/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

28

1400000000462

RSUD MAMUJU

JL KURUNGAN BASSI

21107

PER/028/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

29

1400000000189

RSUD PANGKEP

JL ST HASANUDDIN KABUPATEN PANGKEP

2311118

ARMAN

PER/017/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

30

1400000000339

RSUD PROF. DR. H. M. ANWAR MAKKATUTU

JL. TERATAI NO. 20 BANTAENG

23126

PEMERINTAH KAB. BANTAENG

PER/023/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

19

1500000000299

RSUD BARRU

20

1400000000338

RSUD H. ANDI SULTHAN DAENG RADJA

JL. SERIKAYA NO 17 BULUKUMBA

21

1500000000033

RSUD HAJI MAKASSAR

JL DG MASEPPE

22

1400000000171

RSUD HAJI PADJONGA DAENG NGALLE

JL INCE HUSEIN DAENG PARANI NO 1

23

1500000000021

RSUD KONDOSAPATA' KAB. MAMASA

24

1400000000345

25

MA11222I

84637

PEMERINTAH KAB BULUKUMBA

21065

21004


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NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

NO IKS

31

1400000000172

RSUD SALEWANGANG MAROS

JL POROS MAROS MAKASSAR KM 3

371166

32

1400000000077

RSUD SAYANG RAKYAT MAKASSAR

JL. PAHLAWAN NO. 1000 KEL. BULUROKENG KEC. BIRINGKANAYA

5068931

33

1500000000480

RSUD SYEKH YUSUF KABUPATEN GOWA

JL DR WAHIDIN SUDIRO HUSODO NO 48 SUNGGUMINASA

99257248

34

1500000000111

RSUP DR WAHIDIN SUDIROHUSODO MAKASSAR

JL PERINTIS KEMERDEKAAN KM 11 TAMALANREA

35

1400000000162

RUMAH SAKIT BHAYANGKARA MAKASSAR

JL. LETJEND. POL. MAPPAOUDANG NO. 63

KANTOR CABANG

NO

KODE PROVIDER

:

836344

PEMERINTAH PROVINSI SULAWESI SELATAN

KEPOLISIAN NEGARA REPUBLIK INDONESIA

TIPE IKS

AWAL IKS

AKHIR IKS

PER/015/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

PER/007/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

PER/030/012016

RS.TRAUMA CENTRE

14/03/2016

15/01/2018

PER/003/012016

RS.TRAUMA CENTRE

01/03/2016

04/01/2018

PER/010/012016

RS.TRAUMA CENTRE

14/03/2016

04/01/2018

W01- KANTOR CABANG KENDARI

NAMA PROVIDER

ALAMAT

1

1400000000193

BLUD RSU KONAWE SELATAN

JL POROS ANDOLOO NO.1

2

1400000000293

RS SANTA ANNA KENDARI

JL. DR. MOH HATTA NO 65 A

3

1400000000062

RSUD KOTA KENDARI

JL BRIGJEN Z.A SUGIANTO NO.39

4

1400000000381

RSUD KAB KOLAKA (BLUD)

JL.WR SUPRATMAN NO 20

MA11222I

PIMPINAN

KODE POS

IKS TELEPON

PIMPINAN NO IKS

41916365

32213700

TIPE IKS

AWAL IKS

AKHIR IKS

PEMERINTAH KABUPATEN KONAWE SELATAN

PER/003/032016

RS.TRAUMA CENTRE

09/05/2016

28/03/2018

PT CITRA RATNA NIRMALA

PER/015/022016

RS.TRAUMA CENTRE

22/02/2016

31/01/2017

DINAS KESEHATAN KOTA KENDARI

PER/004/012016

RS.TRAUMA CENTRE

22/02/2016

04/02/2017

DINAS KESEHATAN KOLAKA

PER/002/022016

RS.TRAUMA CENTRE

25/02/2016

08/02/2018


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ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

5

1400000000422

RSUD KAB KONAWE

JL. DIPONEGORO NO 301

DINAS KESEHATAN KAB.KONAWE

PER/011/042016

RS.TRAUMA CENTRE

09/05/2016

03/04/2018

6

1400000000230

RSUD KOTA BAU BAU

JL LA ODE MANARFA

DINKES KESEHATAN KOTA BAU BAU

PER/008/022016

RS.TRAUMA CENTRE

09/05/2016

01/02/2018

KANTOR CABANG

NO

:

KODE PROVIDER

W02- KANTOR CABANG PALOPO

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

1

1500000000097

DR YAIN PANGGALO

JL PONGTIKU RANTEPAO

255009811

DR YAIN PANGGALO

PER/01/012016

RS.TRAUMA CENTRE

01/03/2016

31/12/2016

2

08339

RS BINTANG LAUT PALOPO

K. H. M KASIM NO. 5

21302

YAYASAN RATNA MIRIAM

PER/12/032015

RS.TRAUMA CENTRE

25/02/2016

29/02/2016

KANTOR CABANG

NO

1

:

KODE PROVIDER

NAMA PROVIDER

7-2015740298

KANTOR CABANG

MA11222I

W21- KABUPATEN SINJAI

RSUD SINJAI

:

ALAMAT

JLN JEND SUDIRMAN NO. 47 SINJAI

KODE POS

92611

IKS TELEPON

PIMPINAN NO IKS

048221132

PEMERINTAH DAERAH KAB SINJAI

PER/002/012016


AWAL IKS 16/02/2016


X00- KANTOR CABANG BALI DENPASAR


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NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

NO IKS

13/04/2016

28/02/2017

DR I NYOMAN SUSILA, M.KES

PER/07/022016

RS.TRAUMA CENTRE

13/04/2016

31/01/2018

PER/02/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

PER/01/2016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

PER/05/012016

RS.TRAUMA CENTRE

05/01/2016

31/12/2016

32701

PER/06/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

766154

PER/03/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

PER/09/032016

RS.TRAUMA CENTRE

14/04/2016

28/02/2018

PER/04/012016

RS.TRAUMA CENTRE

08/01/2016

31/12/2016

JL IMAM BONJOL 603 DENPASAR

2

1500000000653

BRSUD TABANAN

JL. PAHLAWAN NO. 14 TABANAN

3

1400000000484

RS SURYA HUSADHA DENPASAR

JL PULAU SERANGAN NO 7 DENPASAR

4

1400000000483

RS SURYA HUSADHA UBUNG

JL COKROAMINOTO NO 356

5

1200000000017

RSU BHAKTI RAHAYU DENPASAR

JL GATOT SUBROTO II NO 11 DENPASAR

430270

6

1400000000554

RSU PARAMA SIDHI

JLN. AHMAD YANI NO. 171A SINGARAJA

7

1400000000482

RSU SURYA HUSADHA NUSA DUA

JL SILIGITA BLOK I NO 14 NUSA DUA

8

7-2919990413

RSUD BULELENG

JL NGURAH RAI NO 30 SINGARAJA BULELENG

9

1400000000485

SILOAM HOSPITAL BALI

JALAN SUNSET ROAD NO 818 KUTA

MA11222I

:

AKHIR IKS

RS.TRAUMA CENTRE

BLK PROPINSI BALI

KANTOR CABANG

AWAL IKS

PER/08/022016

1500000000504

811027

233787

81111

TIPE IKS

UPT BLK-IP BALI

1

82111

PIMPINAN

036222046

779900

PUTU IVAN YUNATANA

RSUD BULELENG

X01- KANTOR CABANG KUPANG


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NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

NO IKS

1

7-2064672333

KILNIK KUPANG GRAHA MEDIKA

JALAN BUNDARAN PU NOMOR 54C KUPANG

2

1100000000003

PROF DR WZ JOHANNES KUPANG

JL M HOTTA NO 19

3

1400000000288

RS BHAYANGKARA KUPANG

JL NANGKA 84 KUPANG

85111

821999

4

7-3100749143

RS ST CAROLUS BORROMEUS

JL. PROF. H.R KOROH KM 08, BELO, KUPANG

85146

00030530

5

1500000000469

RST WIRASAKTI KOTA KUPANG

JALAN MOH HATTA NOMOR 11 KUPANG

6

1400000000417

RSUD DR TC HILLERS MAUMERE

JALAN WAIRKLAU MAUMERE

7

1500000000064

RSUD KAB SABU RAIJUA

JALAN TRANS SEBA BOLOU KM 7 MENIA SABU

8

1400000000565

RSUD MGR GABRIEL MANEK ATAMBUA

JALAN DR SOETOMO NO 02 ATAMBUA

9

1400000000394

RSUD UMBU RARA MEHA WAINGAPU

JALAN ADAM MALIK NO 54 WAINGAPU

10

7-2537666813

RUMAH SAKIT KATHOLIK MARIANUM HALILALUK

JALAN PAROKI ROH KUDUS HALILALUK ATAMBUA

85713

11

7-2240138189

RUMAH SAKIT KRISTEN LINDI MARA

JALAN PROF WZ YOHANNES NOMOR 06

87111

12

1500000000119

RUMAH SAKIT PANGKALAN TNI AU EL TARI

JL ADI SUCIPTO NO 2 KUPANG

MA11222I

85111

PIMPINAN AWAL IKS

AKHIR IKS

PER/ 008/ 022016

RS.TRAUMA CENTRE

18/02/2016

17/02/2017

PER/ 016/ 032016

RS.TRAUMA CENTRE

17/03/2016

15/03/2017

POLRI / POLDA NTT

PER/ 017/ 102015

RS.TRAUMA CENTRE

22/01/2016

31/12/2016

YAYASAN ELISABETH GRUYTERS

05/PKS/RSCB/IV /2016

RS.TRAUMA CENTRE

27/04/2016

18/04/2017

PER/ 018/ 042016

RS.TRAUMA CENTRE

27/04/2016

18/04/2017

PER/ 005/ 012016

RS.TRAUMA CENTRE

28/01/2016

31/12/2016

PER/ 011/ 02016

RS.TRAUMA CENTRE

24/02/2016

24/02/2017

21016

PER/ 003/ 012016

RS.TRAUMA CENTRE

28/01/2016

31/12/2016

61302

PER/ 007/ 012016

RS.TRAUMA CENTRE

01/02/2016

30/01/2017

YAYASAN MARIA VIRGO

PER/ 014/ 032016

RS.TRAUMA CENTRE

17/03/2016

15/03/2017

YUMERKRIS

PER 010/ 022016

RS.TRAUMA CENTRE

24/02/2016

24/02/2017

TNI AU

PER/ 004/ 012016

RS.TRAUMA CENTRE

28/01/2016

31/12/2016

85852420

PT. KUPANG GRAHA MEDIKA

TIPE IKS

2426133

3838123


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

NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

13

1400000000543

RUMAH SAKIT PENYANGGA PERBATASAN BETUN

JALAN SUKABIHANAWA DESA KAMANASA MALAKA TENGAH

14

7-2556506581

RUMAH SAKIT UMUM SILOAM

JALAN RW MONGINSISI FATULULI OEBOBO

85111

15

7-1708103837

SILOAM HOSPITALS LABUAN BAJO

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

86754

16

1500000000438

UPT PELATIHAN TENAGA KERJA DINAS NAKERTRANS PROVINSI NTT

JALAN THAMRIN NO 03 KAYU PUTIH

KANTOR CABANG

NO

KODE PROVIDER

:

PIMPINAN NO IKS

85309000

TIPE IKS

AWAL IKS

AKHIR IKS

PER/ 09/ 022016

RS.TRAUMA CENTRE

15/02/2016

09/02/2017

PT KRISOLIS JAYA MANDIRI

PER/ 015/ 032016

RS.TRAUMA CENTRE

17/03/2016

16/03/2017

PT LINTAS BUANA JAYA

PER/ 006/ 012016

RS.TRAUMA CENTRE

29/01/2016

29/01/2017

PER/ 013 / 032016

RS.TRAUMA CENTRE

17/03/2016

15/03/2017

833270

X03- KANTOR CABANG MATARAM

NAMA PROVIDER

ALAMAT

1

7-2053953083

RS H.L. MANAMBAI ABDULKADIR

JL LINTAS SUMBAWA-BIMA KM 5 KAB SUMBAWA BESAR

2

1400000000433

RSUD BIMA

JL LANGSAT NO 1 RABA KOTA BIMA

3

7-2305763363

RSUD DR R SOEDJONO SELONG

JL PROF M YAMIN NO 55 SELONG KAB LOMBOK TIMUR

4

1400000000513

RSUD KABUPATEN DOMPU

5

1400000000396

RSUD KABUPATEN LOMBOK UTARA

MA11222I

IKS TELEPON

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

803801361

DR H SYAMSUL HIDAYAT

PER/21/122015

RS.TRAUMA CENTRE

18/02/2016

31/12/2016

43142

DRG H IHSAN

PER/25/112015

RS.TRAUMA CENTRE

29/03/2016

31/12/2016

863445444

DR H KARSITO SPPD

PER/23/102015

RS.TRAUMA CENTRE

01/03/2016

31/12/2016

JL KESEHATAN NO 01 KAB DOMPU

21411

DR H AHMAD FAISAL

PER/05/012016

RS.TRAUMA CENTRE

09/05/2016

31/12/2016

JL RAYA TANJUNG - BAYAN, KEC TANJUNG

6147758

DR H LALU BAHARUDIN

PER/24/102015

RS.TRAUMA CENTRE

29/03/2016

31/12/2016

84311

83611


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

6

1500000000061

RSUD KABUPATEN SUMBAWA BARAT

JALAN UNDRU NO 6 KEC TALIWANG

7

7-2043435163

RSUD KOTA MATARAM

JALAN BUNG KARNO NO 3 PAGUTAN MATARAM

8

1400000000259

RSUD PATUT PATUH PATJU

JL H L ANGGRAT BA NO 2 KEC GERUNG

9

7-2055355604

RSUD PRAYA

JL H LALU HASYIM NO 02 KEL TIWU GALI KEC PRAYA KAB LOMBOK TENGAH

10

7-2094061443

RSUD PROVINSI NTB

11

7-2306934144

RSUD SUMBAWA

KANTOR CABANG

NO

KODE PROVIDER

:

KODE POS

IKS TELEPON

NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

8281057

DR HJ DWIWIDIA MERTASARI

PER/03/012016

RS.TRAUMA CENTRE

09/05/2016

31/12/2016

907545167

DR H.L. HERMAN MAHAPUTRA MKES

PER/02/012016

RS.TRAUMA CENTRE

14/04/2016

31/12/2016

681321

RSUD PATUT PATUH PATJU

PER/06/012016

RS.TRAUMA CENTRE

09/05/2016

31/12/2016

83511

75786619

DR MUZAKIR LANGKIR

PER/22/112015

RS.TRAUMA CENTRE

18/02/2016

31/12/2016

JL PRABURANGKASARI DASAN CERMEN MATARAM

83117

081854700 5

DR H MAWARDI HAMRY MPPM

PER/01/012016

RS.TRAUMA CENTRE

23/02/2016

31/12/2016

JL GARUDA NO 5 SUMBAWA BESAR

84311

909048313

DR SELVI

PER/04/012016

RS.TRAUMA CENTRE

14/04/2016

31/12/2016

83117

X04- KANTOR CABANG BALI GIANYAR

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

AWAL IKS

AKHIR IKS

RS.TRAUMA CENTRE

22/01/2016

31/12/2016

21470

PER/004/012016

RS.TRAUMA CENTRE

29/03/2016

31/12/2016

21172

PER/005/012016

RS.TRAUMA CENTRE

22/01/2016

31/12/2016

1500000000114

KLINIK PENTA MEDIKA

JL. RAYA MANGGIS 88

41909

2

1400000000395

RSUD KARANGASEM

JL. I GUSTI NGURAH RAI AMLAPURA

3

1400000000473

RSUD KLUNGKUNG

JL. FLAMBOYAN NO 40 SEMARAPURA

DR. A A GEDE YUDI YUNARDHANA PUTRA

TIPE IKS

PER/006/012016

1

MA11222I

PIMPINAN


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NO

KODE PROVIDER

NAMA PROVIDER

ALAMAT

KODE POS

IKS TELEPON

PIMPINAN NO IKS

TIPE IKS

AWAL IKS

AKHIR IKS

4

1400000000321

RSUD SANJIWANI GIANYAR

JL. CIUNG WANARA NO. 2

943049

ADD/004/082015

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

5

1400000000321

RSUD SANJIWANI GIANYAR

JL. CIUNG WANARA NO. 2

943049

PER/003/012016

RS.TRAUMA CENTRE

22/01/2016

31/12/2017

6

1500000000724

RUMAH SAKIT ARI ÇANTI

JL. RAYA MAS UBUD

976508

DR. I WAYAN ARYAWAN

PER/009/042016

RS.TRAUMA CENTRE

08/04/2016

31/03/2017

7

7-3047982743

RUMAH SAKIT JIWA PROVINSI BALI

JL. KUSUMA YUDHA NO 29 BANGLI

036691073

DR. GEDE BAGUS DARMAYASA, M.REPRO

PER/010/042016

RS.TRAUMA CENTRE

25/04/2016

31/12/2017

8

1200000000003

RUMAH SAKIT UMUM GANESHA

JL RAYA CELUK,SUKAWATI

298233

DR. GUSTI PUTU DARMIKA.S.KED

PER/002/012016

RS.TRAUMA CENTRE

18/01/2016

31/12/2016

MA11222I

80611


SM0480

DAFTAR JEJARING TRAUMA CENTER DAN FASILITAS KERJASAMA BPJS KETENAGAKERJAAN

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