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Provider Indemnity Per 05 Oktober 2020

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Provider Indemnity Per 05 Oktober 2020 PROVIDER INDEMNITY PER 05 OKTOBER 2020 NO PROPINSI WILAYAH NAMA PROVIDER ALAMAT TELEPON Tanggal Mulai Tanggal Habis 1 NANGGROE ACEH DARUSSALAM KOTA BANDA ACEH KLINIK & APOTEK KF 397 SIGLI JL. PERDAGANGAN NO.1 SIGLI - ACEH RT: RW: Kec.: Dati2:KOTA 065321536 10/1/2019 9/30/2022 BANDA ACEH 2 NANGGROE ACEH DARUSSALAM KOTA BANDA ACEH KLINIK SPECIALIS CEMPAKA LIMA JL. TENGKU M. DAUD BEUREUEH NO 156 RT:0 RW:0 Kec.: 065133345 11/1/2019 10/31/2021 Dati2:KOTA BANDA ACEH 3 NANGGROE ACEH DARUSSALAM KOTA BANDA ACEH KLINIK SPESIALIS CEMPAKA LIMA NEUSU Jl. Malikul Saleh Lr. Mulia No 2-3 Neusu, Aceh RT: RW: Kec.: 065133345 11/1/2019 10/31/2021 Dati2:KOTA BANDA ACEH 4 NANGGROE ACEH DARUSSALAM KOTA BANDA ACEH OPTIK SEIS SUZUYA MALL Jl. Teuku Umar (Komplek Suzuya Mall) BANDA ACEH RT: RW: 065122222 6/1/2020 5/31/2022 Kec.: Dati2:KOTA BANDA ACEH 5 NANGGROE ACEH DARUSSALAM KOTA BANDA ACEH RS. CEMPAKA AZ ZAHRA JL.SYAH KUALA RT:0 RW:0 Kec.: Dati2:KOTA BANDA ACEH 065131066 11/1/2019 10/31/2021 6 NANGGROE ACEH DARUSSALAM KOTA BANDA ACEH RS. TEUNGKU FAKINAH JL. JENDRAl sUDIRMAN RT:0 RW:0 Kec.: Dati2:KOTA BANDA 065141454 11/1/2019 10/31/2021 ACEH 7 NANGGROE ACEH DARUSSALAM KOTA BANDA ACEH RS. PERTAMEDIKA UMMI ROSNATI JL. SEKOLAH MO. 5 GAMPONG ATEUK PAHLaWAN RT:0 RW:0 065135092 11/1/2019 10/31/2021 Kec.: Dati2:KOTA BANDA ACEH 8 NANGGROE ACEH DARUSSALAM KAB. ACEH TIMUR RS GRAHA BUNDA JLN MEDAN B.ACEH DESA BUKIT PALA KEC IDI RAYEUK KAB ACEH 064621221 4/1/2020 3/31/2022 TIMUR, ACEH RT:0 RW:0 Kec.: Dati2:KAB. ACEH TIMUR 9 NANGGROE ACEH DARUSSALAM KAB. PIDIE KLINIK MUTIARA SIGLI JL. PROF A. MADJID IBRAHIM NO. 10, SIGLI, PIDIE, ACEH 24151 065321529 11/1/2019 10/31/2021 RT:0 RW:0 Kec.: Dati2:KAB. PIDIE 10 NANGGROE ACEH DARUSSALAM KOTA LANGSA KLINIK & APOTEK KF 81 JL. TM.ZEIN NO.1E ,LANGSA RT:0 RW:0 Kec.: Dati2:KOTA 064121020 10/1/2019 9/30/2022 LANGSA 11 NANGGROE ACEH DARUSSALAM KOTA LANGSA KLINIK DR. SYARBAINI, M.KES JL. AHMAD YANI NO. 154-B LANGSA RT:0 RW:0 Kec.: Dati2:KOTA 08111753107 2/1/2019 1/31/2021 LANGSA 12 NANGGROE ACEH DARUSSALAM KOTA LHOKSEUMAWE KLINIK & APOTEK KF 60 JL. MERDEKA NO. 47 B -C LHOKSEUMAWE BANDA ACEH RT:0 064541152 10/1/2019 9/30/2022 RW:0 Kec.: Dati2:KOTA LHOKSEUMAWE 13 NANGGROE ACEH DARUSSALAM KOTA LHOKSEUMAWE RSIA ABBY Jl. Tgk. Chik Ditiro No. 28 Lancang Garam, Lhokseumawe 24351 06456500284 3/1/2020 2/28/2022 RT:0 RW:0 Kec.: Dati2:KOTA LHOKSEUMAWE 14 SUMATRA UTARA KOTA MEDAN KLINIK & APOTEK KF 27 JL. PALANG MERAH NO. 32 RT:0 RW:0 Kec.: Dati2:KOTA MEDAN 0614576023 10/1/2019 9/30/2022 15 SUMATRA UTARA KOTA MEDAN RUMAH SAKIT KHUSUSMATA SMEC JL. ISKANDAR NO. 278 - 280, MEDAN RT:0 RW:0 Kec.: 0614525058 2/1/2019 1/31/2021 Dati2:KOTA MEDAN 16 SUMATRA UTARA KOTA MEDAN KLINIK SPESIALIS BUNDA JL. SISINGAMANGARAJA NO.17 RT: RW: Kec.: Dati2:KOTA 0617321666 1/1/2020 12/31/2021 MEDAN 17 SUMATRA UTARA KOTA MEDAN MEDAN MEDICAL CENTER Kompleks Multatuli Indah Blok BB 56-57, Jalan Multatuli - Medan 06177806860 4/1/2019 3/31/2021 RT:0 RW:0 Kec.: Dati2:KOTA MEDAN 18 SUMATRA UTARA KOTA MEDAN KLINIK TELKOMEDIKA HEALTH CENTER MEDAN JL. TIMOR NO. 25 MEDAN RT:0 RW:0 Kec.: Dati2:KOTA MEDAN 0614101294 7/1/2020 6/30/2022 19 SUMATRA UTARA KOTA MEDAN KLINIK KIMIA FARMA BANDARA KUALANAMU Jl. International Bandara Kualanamu RT: RW: Kec.: Dati2:KOTA 0 10/1/2019 9/30/2022 MEDAN 20 SUMATRA UTARA KOTA MEDAN KLINIK KIMIA FARMA LUBUK PAKAM Jl. Bakaran Batu No. 13/15 Kel. Lubuk Pakam, Medan, Sumatera 0 10/1/2019 9/30/2022 Utara RT:0 RW:0 Kec.: Dati2:KOTA MEDAN 21 SUMATRA UTARA KOTA MEDAN KLINIK KIMIA FARMA J CITY Jl. Karya Wisata Kompleks J City No. 83 Medan RT: RW: Kec.: 0 10/1/2019 9/30/2022 Dati2:KOTA MEDAN 22 SUMATRA UTARA KOTA MEDAN OPTIK SEIS PLAZA MEDAN FAIR JL. JEND. GATOT SUBROTO NO. 30 PLAZA MEDAN FAIR 1ST FLOOR 061-4140745 6/1/2020 5/31/2022 AI RT: RW: Kec.: Dati2:KOTA MEDAN 23 SUMATRA UTARA KOTA MEDAN OPTIK SEIS SUN PLAZA JL. KH. ZAINUL ARIFIN NO. 7 SUN PLAZA GROUND FLOOR A19 & 0614501336 6/1/2020 5/31/2022 20 RT: RW: Kec.: Dati2:KOTA MEDAN 24 SUMATRA UTARA KOTA MEDAN OPTIK SEIS CENTRE POINT MALL JL. JAWA / TIMOR NO. 1 CENTRE POINT MALL UPPER GROUND 17 06180501352 6/1/2020 5/31/2022 RT: RW: Kec.: Dati2:KOTA MEDAN 25 SUMATRA UTARA KOTA MEDAN OPTIK SEIS DELI PARK JL. PUTRI HIJAU / GURU PATIMPUS NO. 1 OPQ LANTAI 2 No. 8 RT: 06162000188 6/1/2020 5/31/2022 RW: Kec.: Dati2:KOTA MEDAN 26 SUMATRA UTARA KOTA MEDAN RSU. PERMATA BUNDA MEDAN JL. SISINGAMANGARAJA, NO.7 RT: RW: Kec.: Dati2:KOTA 0617362777 1/1/2020 12/31/2021 MEDAN PROVIDER INDEMNITY PER 05 OKTOBER 2020 NO PROPINSI WILAYAH NAMA PROVIDER ALAMAT TELEPON Tanggal Mulai Tanggal Habis 27 SUMATRA UTARA KOTA MEDAN RS. ADVENT MEDAN JL. GATOT SUBROTO, KM. 4 RT:0 RW:0 Kec.: Dati2:KOTA 0614524875 4/1/2019 3/31/2021 MEDAN 28 SUMATRA UTARA KOTA MEDAN RS. BUNDA THAMRIN MEDAN JL. SEI BATANG HARI NO. 28/30 MEDAN SUNGGAL RT:0 RW:0 0614553928 1/1/2019 12/31/2020 Kec.: Dati2:KOTA MEDAN 29 SUMATRA UTARA KAB. DELI SERDANG RS. GRANDMED LUBUK PAKAM JL. RAYA MEDAN-LUBUK PAKAM KM 25 NO. 66 RT:0 RW:0 Kec.: 0617955114 1/1/2020 12/31/2021 Dati2:KAB. DELI SERDANG 30 SUMATRA UTARA KAB. KARO RS. EFARINA ETAHAM BRASTAGI JL. DJAMIN GINTING, NO.1 DESA RAYA, RT:0 RW:0 Kec.: 0628323716 5/1/2014 1/31/2022 Dati2:KAB. KARO 31 SUMATRA UTARA KOTA MEDAN SILOAM HOSPITALS DHIRGA SURYA MEDAN JL. IMAM BONJOL NO. 6 MEDAN RT:0 RW:0 Kec.: Dati2:KOTA 06188881900 10/1/2020 9/30/2022 MEDAN 32 SUMATRA UTARA KOTA MEDAN RS. ISLAM MALAHAYATI JL. DIPENOGORO NO.2-4, MEDAN RT:0 RW:0 Kec.: Dati2:KOTA 0614518766 1/1/2020 12/31/2021 MEDAN 33 SUMATRA UTARA KOTA MEDAN RS. MATERNA JL. TEUKU UMAR NO.11 RT:0 RW:0 Kec.: Dati2:KOTA MEDAN 0614514222 6/1/2016 12/31/2021 34 SUMATRA UTARA KOTA MEDAN RSIA. SRI RATU JL. NIBUNG RAYA NO 204-212 MEDAN RT:0 RW:0 Kec.: 0614521074 1/1/2020 12/31/2021 Dati2:KOTA MEDAN 35 SUMATRA UTARA KOTA MEDAN RS. ESTOMIHI JL. SISINGAMANGARAJA NO.235 MEDAN RT: RW: Kec.: 0617861771 1/1/2018 12/1/2021 Dati2:KOTA MEDAN 36 SUMATRA UTARA KOTA MEDAN RSIA. STELLA MARIS MEDAN JL. KH Samanhudi No.18 jati RT:0 RW:0 Kec.: Dati2:KOTA MEDAN 0614158383 7/1/2019 6/30/2021 37 SUMATRA UTARA KOTA MEDAN RS. HERNA JL. MAJAPAHIT NO.118A, MEDAN RT:0 RW:0 Kec.: Dati2:KOTA 0614510766 4/1/2019 3/31/2021 MEDAN 38 SUMATRA UTARA KOTA MEDAN RS. COLUMBIA ASIA MEDAN (D/H GLENI MEDAN) JL. LISTRIK 2A MEDAN 20112 RT:000 RW:000 Kec.: Dati2:KOTA 0614566368 1/1/2020 12/31/2021 MEDAN 39 SUMATRA UTARA KOTA MEDAN RS. IMELDA PEKERJA INDONESIA JL. BILAL NO 24 PULO BRAYAN DARAT I MEDAN TIMUR RT:0 0616610072 6/1/2020 5/31/2022 RW:0 Kec.: Dati2:KOTA MEDAN 40 SUMATRA UTARA KOTA MEDAN RS. ROYAL PRIMA MEDAN JL. AYAHANDA NO. 68 A, MEDAN - SUMATERA UTARA RT: RW: 06188813182 1/1/2018 12/31/2021 Kec.: Dati2:KOTA MEDAN 41 SUMATRA UTARA KOTA MEDAN RSU. SUNDARI JL. TB SIMATUPANG NO 31 MEDAN RT:0 RW:0 Kec.: Dati2:KOTA 0618452536 1/1/2020 12/31/2021 MEDAN 42 SUMATRA UTARA KOTA MEDAN RS. MITRA SEJATI MEDAN JL. AH. NASUTION PANGKALAN MAHSYUR NO.7, MEDAN RT:0 0617875967 1/1/2020 12/31/2021 RW:0 Kec.: Dati2:KOTA MEDAN 43 SUMATRA UTARA KOTA MEDAN RS. DELI JL. MERBABU NO.18-20 a, MEDAN RT:0 RW:0 Kec.: Dati2:KOTA 0614565229 1/1/2020 12/31/2021 MEDAN 44 SUMATRA UTARA KOTA MEDAN RSU. MARTHA FRISKA JL. KOL. YOS SUDARS. O KM.6, NO.91, PULO BRAYAN RT: RW: 0616610910 2/1/2015 12/31/2021 Kec.: Dati2:KOTA MEDAN 45 SUMATRA UTARA KOTA MEDAN RSU. SARAH JL. BAJA RAYA NO. 10 PETISAH RT:0 RW:0 Kec.: Dati2:KOTA 0614528744 3/1/2019 2/28/2021 MEDAN 46 SUMATRA UTARA KOTA MEDAN RS. KHUSUS BEDAH SETIA BUDI JL. MESJID NO. 3 TANJUNG REJO, MEDAN RT:0 RW:0 Kec.: 0618220995 1/1/2020 12/31/2021 Dati2:KOTA MEDAN 47 SUMATRA UTARA KOTA MEDAN RS. MADANI MEDAN JL. A.R. HAKIM NO. 168, KEL. SUKA RAMAI I, KEC. MEDAN AREA, 0617345911 1/1/2020 12/31/2021 KOTA MEDAN RT: RW: Kec.: Dati2:KOTA MEDAN 48 SUMATRA UTARA KOTA MEDAN RS. ST ELISABETH - MEDAN JL. H. MISBAH NO.7, MEDAN RT:0 RW:0 Kec.: Dati2:KOTA 0614521957 6/1/2019 5/31/2021 MEDAN 49 SUMATRA UTARA KOTA MEDAN RSU. PROF.DR.BOLONI JL. W. MONGINSIDI NO. 11 MEDAN RT:0 RW:0 Kec.: Dati2:KOTA 0614512687 4/1/2019 3/31/2021 MEDAN 50 SUMATRA UTARA KOTA MEDAN MURNI TEGUH MEMORIAL HOSPITAL JL JAWA NO 2 (SIMPANG JL VETERAN) DELI SERDANG RT:0 RW:0 06180501888 1/1/2020 12/31/2021 Kec.: Dati2:KOTA MEDAN 51 SUMATRA UTARA KOTA MEDAN RS.
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