Daftar Sarkes Ctki 07082017

Lampiran Surat
Nomor : YK.01.01/V.1/2975/2017
Tanggal : 6 Juli 2017
DAFTAR FASILITAS PELAYANAN KESEHATAN

YANG TELAH DITETAPKAN SEBAGAI SARANA KESEHATAN PEMERIKSA KESEH
NO PROVINSI NAMA SARANA KESEHATAN ALAMAT
1 SUMATERA UTARA 1 RSU Imelda Pekerja Indonesia Jl. Bilal No. 24 Pulo Brayan Darat I, Kec. Medan Timur
2 Klinik Utama Spesialis Anugerah Ibu Jl. Nibung Raya No. 28, Medan
3 Klinik Utama Medan Medical Center Jl. Multatuli Kompleks Multatuli Blok BB 56-57 , Medan 20151
4 Klinik Global Health Jl. Mojopahit No. 88 EF, Medan 20112
2 SUMATERA BARAT 1 RSU Pariaman Jl. Prof. M. Yamin SH No. 5, Pariaman

2 Semen Padang Hospital Jl. By Pass Km. 7 Kel pisang Kec Pauh, Padang, Sumbar
3 JAMBI 1 RSUD Raden Mattaher Jambi Jl. Let Jend Soeprapto No. 32 Telanaipura Jambi
Komplek Taman Niaga Blok J No. 3A dan 5, Sukajadi, Kel. Baloi

4 KEPULAUAN RIAU 1 Klinik Utama Medilab
Permai Kec. Nongsa Kab. Batam-Kepri
5 LAMPUNG 1 Klinik Utama Assalam Medical Center Jl. Raya Pemanggilan Komplek ESI Umbul Thoif, Kec. Natar
1
2 RSUD Dr. H. Abdul Moeloek Jl. Dr. Rivai No. 6 Bandar Lampung
6 DKI JAKARTA 1 RSUD Koja Jl. Deli No. 4, Tanjung Priok Jakarta Utara
2 RSU Pasar Rebo Jl. TB Simatupang No. 30 Jakarta Timur
3 RSU Tarakan Jl. Kyai Caringin Jakarta Pusat
4 RS Pelabuhan Jl. Kramat Jaya Tanjung Priok , Kel Tugu Utara, Kec Koja
4 Klinik Utama Afiat Medical Centre Jl. Dukuh V No.100 RT.11 RW.05 Kel. Dukuh Kec.Kramat Jati
5 Klinik Utama Amalia Medical Centre Jl. Dewi Sartika No. 364 A Kel. Cawang, Kec.Kramat Jati-JakTim
6 Klinik Utama Amanah Medika Pura Jl. Tebet Raya No. 31 Rt/Rw. 02/02, Kel. Tebet Timur, Kec Tebet
Jl. K.H. Abdullah Syafi'i No. 12 Rt/Rw. 005/011, Kel Tebet Timur,
7 Klinik Utama An Nur Medical Center
Kec Tebet
Jl. Kampung Melayu Besar No. 13 Rt/Rw. 011/001, Kel Bidara
8 Klinik Utama Ar Ridha Medical Center
Cina, Kec. Jatinegara Jakarta Timur
9 Klinik Utama Assa'adah Medical Centre Jl. Tebet Timur Dalam Raya No. 58 , Jakarta Selatan
10 Klinik Utama Ar Raudah Medical Center Jl. Tebet Timur Dalam II No.30, Jakarta Selatan
Jl. Dewi Sartika No. 352 RT/RW,004/004 Kel. Cawang Kec.
11 Klinik Utama Azzahra Medical Center
KramatJati Jakarta Timur
12 Klinik Utama Bakthir Medical Center Jl. Raya Condet No. 6 Kel. Cililitan Kec. Kramat Jati, Jaktim
13 Klinik Utama Dewi Sartika Medical Center Jl. Raya Condet No. 39, Jakarta Timur
14 Klinik Utama Haninah Medical Center Jl. Budi No. 20 Kel. Cawang, Kec. Kramat Jati, Jakarta Timur
2
Jl. Tebet Timur Dalam VI No. 10 RT/RW 006/08 Kel. Tebet
15 Klinik Utama Hidayah Mecial Centre
Timur Kec. Tebet Jakarta Selatan
16 Klinik Utama Insani Medical Centre Jl. Basuki Rahmat No. 18 Jatinegara, Jakarta Timur
Jl. Raya Bekasi Timur No. 122 B-C, Kel Cipinang Besar Utara,
17 Klinik Utama Medikal Haji Jakarta
Kec. Jatinegara, Jakarta Timur
18 Klinik Utama Nur Huda Medical Centre Jl. Otista II No. A13 Jakarta Timur
Klinik Utama Permata Indah Medical Perumahan Taman Permata Indah II , Blok E No. 8 Kel.
19
Centre Pejagalan, Kec. Penjaringan, Jakarta Utara
Jl. Tebet Timur Dalam Raya No. 113 Kel. Tebet Timur Kec.
20 Klinik Utama Rayhan Medical Centre
Tebet - Jakarta Selatan
Jl. KH. Abdullah Syafi'i Gudang Peluru, Blok A No. 18 Kel
21 Klinik Utama Salamat Medical Centre
Kebon Baru Kec. Tebet, Jakarta Selatan
Jl. Asem Baris Raya No. 3A-B Kel. Kebon Baru , Kec Tebet,
22 Klinik Utama Tihama Medical Centre
Kotamadya Jakarta Selatan
Jl. Rosela Raya No. 185 Kel. Wijaya Kusuma , Kec Grogol
23 Klinik Utama Rosela Indah Medical Centre
Petamburan, Jakarta Barat
24 Klinik Utama Al Hikmah Medical Center Jl. Asem Baris No. 15, Tebet Jakarta Selatan
Klinik Utama Satria Medika Sakti Medical Jl. Hayam Wuruk No. 100R Kel. Maphar Kec. Taman Sari
25
Center Jakarta Barat
Jl. Asem Baris Raya No. 147, Kel. Kebon Baru Kec Tebet,
26 Klinik Utama Setu Medical Center
Jakarta Selatan 12830
27 RSUP Persahabatan Jl. Persahabatan Raya No. 1, Jakarta Timur
3
7 JAWA BARAT 1 RSUD R. Syamsudin, SH Jl. Rumah Sakit No. 1, Sukabumi.
2 RS Pelabuhan Cirebon Jl. Sisingamangaraja No. 45, Kota Cirebon-45112

3 RS Mitra Plumbon Jl. Raya Plumbon Km. 11, Cirebon
4 Klinik Utama Sa'adah Bina Medika Jl. Pangeran Diponegoro No. 27 Cirebon Jawa Barat
5 RSUD Waled Jl. Prabukiansantang No. 4, Kab Cirebon
6 RSUD Kabupaten Indramayu Jl. Murah Nara No. 7, Kabupaten Indramayu
Jl. Galuh Mas Raya No.1 , Sukaharja, Telukjambe Timur,
7 RSUD Kabupaten Karawang
Karawang
8 JAWA TENGAH 1 RSUD Kraton Kab. Pekalongan Jl. Veteran 31 Pekalongan

2 Klinik Utama An-Nur Cilacap Jl. MT Haryono No. 60 A, Cilacap
Jl. Perintis Kemerdekaan No. 24, Purwokerto, Kec. Purwokerto
3 Klinik Utama An-Nur Purwokerto
Selatan, Kab. Banyumas
4 Klinik Utama Budi Sehat Jl. S. Parman No. 131, Surakarta
5 Klinik Utama Centrum Kendal Jl. Tentara Pelajar No. 25 Purin, Kendal
6 Klinik Utama Centrum Jl. Pusponjolo Barat Raya No. 14 Smg 50141
4
7 Klinik Utama Imam Bonjol Jl. Imam Bonjol 177A Semarang 50131
8 Klinik Utama Permata Semarang Jl. Mayjen Soetoyo S No. 962 A
9 Keluarga Sehat Hospital Jl. Jendral Sudirman No. 9 Margorejo, Pati
10 Klinik Utama Ultra Medika Jl. Ronggolawe No. 83 Karangayu, Semarang
11 Klinik Utama An Nur Wonosobo Jl. Raya Dieng Km.3 No. 90, Bugangan, kalianget, Wonosobo
12 RSUD DR. H. Soewondo Jl. Laut No. 21, Kabupaten Kendal, Jawa Tengah 51311
9 DI YOGYAKARTA 1 RSUD Kota Yogyakarta Jl. Wirosaban No. 1 Yogyakarta

Ruko Tandan Raya C6-C7, Ring Road Wonosari, Banguntapan-
2 Klinik Utama An Nur Medical Center
Bantul, Yogyakarta
3 Klinik Utama Ultra Medica Jl. Menteri Supeno Gg. Soka No. 1021 A Yogyakarta
4 Klinik Utama Spesialis Anugerah Ibu Jl. Raya Solo KM.11.5, Purwomartani, Kalasan Sleman
10 JAWA TIMUR 1 RS Blambangan Banyuwangi Jl. Letkol Istglah No. 49 Banyuwangi

2 RS Islam Jemur Sari Jl. Jemursari No. 51 - 57 Surabaya
3 RSUD Caruban Kab. Madiun Jl. A. Yani Km. 2 Caruban Kab Madiun
4 RSD Dr. Soebandi Jember Jl. Dr. Soebandi No. 124, Jember
5 Klinik Utama Central Medical Jl. Untung Suropati No. 35B, Sidoarjo
6 Klinik Utama Citra Medical Center Jl. Ketintang Baru III No. 56
5
7 Klinik Utama As Shafa Jl. Letnan Jenderal Sutoyo No. 11, Medaeng Waru, Sidoarjo
8 Klinik Utama Karya Nusantara Medica Jl. Maninjau Raya 33 Sawojajar Malang
9 Klinik Utama Dialisa Jl. Jemur Andayani 50 Blok D No.33-35
10 Klinik Utama Ultra Medica Kediri Jl. Teuku Umar No. 4 kel. Ngadirejo, Kec.Kota Kediri
Jl. Batoro Katong 187A, Kel. Patihan Wetan, Kec. Babadan,
11 Klinik Utama Ultra Medica Ponorogo
Kab. Ponorogo
12 Klinik Utama Ultra Medica Surabaya Jl. Nias No. 26, Surabaya
13 Klinik Utama Panglima Sudirman Jl. R. Tumenggung Suryo No. 22, Malang- Jawa Timur
14 Klinik Utama Higina Medical Centre Jl. Kaliurang No. 30, Malang
15 RS Siti Khodijah Sepanjang Jl. Pahlawan No. 260, sepanjang - Jawa Timur
16 Klinik Utama Argaraya Jl. Kalpataru 39 Malang
11 BALI 1 Klinik Utama Quantum Sarana Medik Jl. Raya Sesetan No. 20 Denpasar
2 RSUD Sanjiwani Gianyar Jl. Ciung Wenara No. 2, Gianyar Bali

Klinik Utama Padma Bahtera Medical Jl. Hayam Wuruk No.240 Sumerta Kelod, Denpasar Timur
3 Centre
4 Klinik Utama Merdeka Medical Center Jl. Merdeka VIII No. 2, Denpasar Bali
6
12 NUSA TENGGARA 1 Klinik Utama Alumni Agung Jl. Bung Karno No. 2, Mataram - NTB
BARAT
Jl. Pandawa No. 19 Kel. Cilinaya Kec Cakranegara, Kota
2 Klinik Utama Nugraha
Mataram
Kompleks Ruko Bertais Blok U No.43, Jl.Sandubaya, Kota
3 Klinik Utama Spesialis Anugerah Ibu
Mataram
4 Klinik Utama Rayhana Medical Center Jl. Bung Hatta No. 14 Mataram - Lombok
Jl. Raya Paoq Motong Desa Danger Kec. Masbagik, Lombok

5 Klinik Utama Global Medika
Timur
6 Klinik Utama Citra Medical Centre Jl. RA. Kartini No. 24 Rakam, Selong
7 Klinik Utama Praya MC Jl. Sukarno - Hatta No. 11, Leneng Praya Lombok Tengah
8 Klinik Utama Mataram Medical Center Jl. Sandubaya No. 36, Bertais, Mataram
NUSA TENGGARA
13 1 Klinik Utama Citra Kupang Jl. Mohammad Hatta No.11, Fontein- Kupang- NTT
TIMUR
14 KALIMANTAN BARAT 1 RSU Santo Antonius Pontianak Jl. KH. Wahid Hasyim
2 RSUD Pemangkat Jl. A Kadir Kasim No. 20 , Pemangkat
Jl. Jenderal Sudirman No. 01, Kel Beringin, Kec Kapuas,
3 RSUD M. TH. Djaman
Sanggau
7
15 KALIMANTAN TIMUR 1 RSUD AM Parikesit Tenggarong Jl. Imam Bonjol No. 37 Tenggarong
16 KALIMANTAN UTARA 1 RSUD Nunukan Jl. Sungai Fatimah, Nunukan
17 SULAWESI SELATAN 1 RSUD Andi Makkasau Pare Pare Jl. Nurussamawati No. 9, Kota Pare Pare
18 SULAWESI TENGAH 1 RS Bhayangkara Palu Jl. Dr. Suharso No. II, Palu, Sulawesi Tengah
96
8
HATAN
ERIKSA KESEHATAN CALON TKI
TELEPON e mail Nomor SK dan Masa Berlaku
(061) 6610072, 6631380 info@rsuimelda.co.id HK.02.03/I/0480/2016, 22 Maret 2019
(061) 4147785, 4147782 mailbox@anugerahibu.com HK.02.03/I/0500/2016, 22 Maret 2019
(061) 4535522, 4510609 medanmedicalcenter@gmail.com HK.02.03/I/1171/2016, 1 Juni 2019
(062 / 061) 4150389, 4524403 sarkesblessing@gmail.com HK.02.03/I/2700/2016, 5 September 2019
(0751) 91118 rsudpariaman_sumbarprov@yahoo.com HK.02.03/I/0497/2016, 22 Maret 2019
(0751)777888/4782990 marketing.semenpadanghospital@gmail.com HK.02.03/I/0500/2016, 22 Maret 2019
(0741) 616921 HK.02.03/I/0479/2016, 22 Maret 2019
(0778) 7372022 Fax. 7372024 operasional@medilab-clinic.com ; customercare@medilab-clinic.com

HK.02.03/I/0479/2016, 22 Maret 2019
(0721) 8013567 assalammedical_lampung@yahoo.co.id HK.02.03/I/0553/2015, 2 Maret 2018
9
(0721) 703312 pelayanan.rsudam@gamil.com HK.02.02/I/3216/2017, 24 Juli 2020
(021) 43938478 rsudkoja@yahoo.com HK.02.03/I/0496/2016, 22 Maret 2019
(021) 8401127 rsudpasarrebo@yahoo.com HK.02.03/I/0482/2016, 22 Maret 2019
(021) 3503150/3842934 info@rstarakanjakarta.com HK.02.03/I/0492/2016, 22 Maret 2019

(021)44837582/44837581 contact@rspelabuhan.com HK.02.03/I/2019/2014, 12 Agustus 2017
(021) 87791834 fax. 87791855 afiatmedicalcenter@yahoo.co.id HK.02.03/I/0488/2016, 22 Maret 2019
(021) 8000344, 8017211 info@amaliamedicalcenter.com HK.02.03/I/0870/2016, 29 April 2019
(021) 83792701, 83792702 amanah@medikapura.com HK.02.03/I/1146/2016, 25 Mei 2019
(021) 8307804, 8299132 annur_med@yahoo.co.id HK.02.03/I/0520/2016, 28 Maret 2019
(021) 8190580, 8519038 /8519039 arridhamc@yahoo.com HK.02.03/I/0913/2016, 4 Mei 2019
(021) 8297255, 83791386, 83791518 admin@assaadah-clinic.com HK.02.03/I/2696/2016, 5 September 2019
(021) 83781151/83701152 ar.raudahmedicalcenter@yahoo.com HK.02.03/I/0914/2016, 4 Mei 2019
(021) 8090590/8011975
azzahra_mc@cbn.net.id HK.02.03/I/3400/2016, 21 Oktober 2019
(021) 80885302, 8092850, 8097584 HK.02.03/I/0672/2016, 12 April 2019
(021) 80883405-06/80883404 dsmc_condet@yahoo.com HK.02.03/I/0517/2016, 28 Maret 2019
(021) 8010318, 80877148 mchaninah@yahoo.co.id HK.02.03/I/0915/2016, 4 Mei 2019
10
(021) 8353604/83706158 bakthirmc@yahoo.co,id HK.02.03/I/2697/2016, 5 September 2019
(021) 85768013, 85911505, 85911506 insanimc@indosat.net.id HK.02.03/I/0869/2016, 29 April 2019
(021) 8570602, 8570601 mcuhaji@yahoo.com HK.02.03/I/1332/2015, 15 Mei 2018
(021) 8566945, 8508331 nurhuda@cbn.net.id HK.02.03/I/2512/2016, 16 Agustus 2019
(021) 6680843, 6618894 permata_vika2003@yahoo.com HK.02.03/I/1145/2016, 25 Mei 2019
(021) 8301151-52/8292121 rayhanku@gmail.com; rayhanjkt@yahoo.com HK.02.03/I/0872/2016, 29 April 2019
slmmc18@yahoo.com
(021) 83795988, 829115593 HK.02.03/I/0609/2016, 7 April 2019
kliniksalamat@gmail.com
(021) 8280621, 8280632, 8280667,
mytihama@gmail.com HK.02.03/I/0871/2016, 29 April 2019
8280639
(021) 5643405, 56978252 rosella_medical@yahoo.com HK.02.03/I/0631/2016, 7 April 2019
alhikmah@yahoo.com
(021) 83792398 HK.02.03/I/3405/2016, 21 Oktober 2019
alhikmah_med@yahoo.com
(021) 6288149, 6281480 satriamedica@yahoo.co.id HK.02.03/I/3758/2016, 10 Nopember 2019
(021) 8291494 Fax 83705327 kliniksetu@yahoo.com HK.02.03/I/2698/2016, 5 September 2019
(021) 4891708 Fax 4711222 info@rsuppersahabatan.co.id HK.02.03/I/3218/2017, 24 Juli 2020
11
rsu_syamsudin@sukabumi.wasantara.net.id
(0266) 225180 HK.02.03/I/0483/2016, 22 Maret 2019
rsu_syamsudin@pdpersi.co.id
(0231) 205657 HK.02.03/I/2211/2015, 31 Juli 2018
(0231) 323100 rsmitraplumbon@yahoo.com HK.02.03/I/0490/2016, 22 Maret 2019
(0231) 232717/220258 saadahcirebon@yahoo.com HK.02.03/I/1144/2016, 25 Mei 2019
(0231) 661126 brsud.waled@gmail.com HK.02.03/I/4126/2016, 6 Desember 2019
(0234) 272655 rsudkabindramayu@yahoo.co.id HK.02.02/I/2732/2017, 5 Juli 2020
(0267) 640444
rsudkrw@yahoo.co.id HK.02.02/I/2734/2017, 6 Juli 2020
(0285) 421621 rsudkraton@yahoo.co.id HK.02.03/I/0522/2016, 28 Maret 2019
(0282) 534144, 534646 cilacap@annurmedical.com HK.02.03/I/0498/2016, 22 Maret 2019
(0281) 621829 annurpwt@yahoo.com HK.02.03/I/0484/2016, 22 Maret 2019
(0271) 648026 info@budisehat.com HK.02.03/I/2860/2016, 9 September 2019
(0294) 3689949 Fax. 383223 centrumkendal@yahoo.com HK.02.03/I/1329/2015, 15 Mei 2018
(024) 7614767 Fax. 7626567 centrumsmg@yahoo.com HK.02.03/I/1331/2015, 15 Mei 2018
12
(024) 3553188/3562595 ibl_klinik@yahoo.com HK.02.03/I/2699/2016, 5 September 2019
(024) 8412270 klinikutamapermata@yahoo.co.id HK.02.03/I/0489/2016, 22 Maret 2019
(0295) 386111 keluargasehat.pati@gmail.com HK.02.03/I/2701/2016, 5 September 2019
(024) 7612920 ultramedica@yahoo.com HK.02.03/I/0493/2016, 22 Maret 2019
(0286) 324262 fax. 324430 annurwonosobo@gmail.com HK.02.02/I/0567/2017, 28 Februari 2020
(0294) 381444 www.rsudkendal.com HK.02.03/I/3220/2017, 24 Juli 2020
(0274) 371195 rsud@jogjakarta.go.id HK.02.03/I/0521/2016, 28 Maret 2019
(0274) 452166 annuryog@yahoo.com HK.02.03/I/0474/2016, 22 Maret 2019
(0274) 370360 ultramedyogya10212@yahoo.com HK.02.03/I/1143/2016, 25 Mei 2019
(0274) 497462 anugerahibu.jogya@gmail.com HK.02.03/I/3404/2016, 21 Oktober 2019
(0333) 421118/421072 rsudblambangan.bwi@gmail.com HK.02.03/I/0472/2016, 22 Maret 2019
(031) 8471877 rsis_js@yahoo.co.id HK.02.03/I/3635/2014, 12 Nov 2017
(0351)387184 rsudcaruban@madiunkab.go.id HK.02.03/I/0495/2016, 22 Maret 2019
(0331) 487564 soebandi@pdpersi.co.id HK.02.03/I/0475/2016, 22 Maret 2019
fellix_central_medical@yahoo.com HK.02.03/I/3639/2014, 12 Nov 2019
(031) 8291214 citramc@yahoo.com HK.02.03/I/0515/2016, 28 Maret 2019
13
(031) 8555001 asshafamed@gmail.com HK.02.03/I/0473/2016, 22 Maret 2019
(0341) 714163 karyanusantaramedica@yahoo.co.id HK.02.03/I/0494/2016, 22 Maret 2019
(031) 70227474 / 8496767 klinikutama.dialisa@gmail.com HK.02.03/I/0518/2016, 28 Maret 2019
(0354) 684696 ultramedkdr@ymail.com HK.02.03/I/0487/2016, 22 Maret 2019
(031) 5032055 ultramedica_po@yahoo.co.id HK.02.03/I/0486/2016, 22 Maret 2019
(031) 5032055 ultramedica@yahoo.com HK.02.03/I/0485/2016, 22 Maret 2019
(0341) 494795/402883 klinik_panglimasudirman@yahoo.co.id HK.02.03/I/0519/2016, 28 Maret 2019
(0341) 368341, 476116 higina_medica@yahoo.com HK.02.03/V.1/3403/2016, 21 Oktober 2019
(031)7881130-7882123/7876066 siti-khodijah@gmail.com HK.02.03/V.1/0501/2017, 23 Februari 2020
(0341) 4345510-4345512 argaraya_medika@yahoo.com YK.01.01/V.1/3087/2017
(0361) 228835 Fax. 245274, legalofficer.quantum@gmail.com HK.02.03/I/3631/2014, 12 Nov 2017
(0361) 943020 sanjwanigianyar@yahoo.com HK.02.02/I/2735/2017, 6 Juli 2020
(0361) 246701/246703 info@pbmcgroup.com HK.02.02/I/3219/2017, 24 Juli 2020
(0361) 233790 info@mmc-bali.com HK.02.02/I/3221/2017, 24 Juli 2020
14
(0370) 633527 alumniagung@yahoo.co.id HK.02.03/I/2214/2015, 31 Juli 2018
(0370) 644749 clinicnugraha@yahoo.co,id HK.02.03/I/0499/2016, 22 Maret 2019
(0370) 673028 anugerahibu.mataram@gmail.com HK.02.03/I/0481/2016, 22 Maret 2019
(0370) 633517/629218 rayhana_mc@ymail.com HK.02.03/I/3633/2014, 14 Nov 2017
(0376) 2926120 klinikglobal.medika@yahoo.com HK.02.03/I/3632/2014, 12 Nov 2017
citraselong@yahoo.com HK.02.03/I/2212/2015, 31 Juli 2018
(0370) 655544/654898 prayamedicalcenter@gmail.com HK.02.03/I/0500/2017, 23 Februari 2020
(0370)672241 matarammc@yahoo.com HK.02.02/I/1348/2017, 15 Mei 2020
citrakupang@yahoo.co.id HK.02.03/I/2213/2015, 31 Juli 2018
(0561) 764259 pemasaranrssa@gmail.com HK.03.05/I/4163/2015, 28 Sept 2018
(0562) 241203 rsupmk@gmail.com HK.02.03/I/0478/2016, 22 Maret 2019
(0564) 21070/22959
HK.02.02/I/2736/2017, 6 Juli 2020
15
(0511) 661015 humas@rsamp.id HK.02.03/I/0523/2016, 28 Maret 2019
(0556) 24416 pkrsudnunukan@yahoo.co.id HK.02.03/I/0476/2016, 22 Maret 2019
(0421)21823 rsudandimakkasau@gmail.com HK.02.02/I/3217/2017, 24 Juli 2020
(0451) 429714 rsbhayangkara@yahoo.co.id HK.02.03/I/0516/2016, 28 Maret 2019
Direktur Fasilitas Pelayanan Kesehatan
dr. Andi Saguni, MA

NIP. 19720117200121001
16
Nomor SK BENTUK
RS KLINIK RUKO RMH

HK.02.03/I/0480/2016, 22 Maret 2016 1
HK.02.03/I/0500/2016, 22 Maret 2016 1
HK.02.03/I/1171/2016, 1 Juni 2016

1
HK.02.03/I/2700/2016, 5 September 2016 1
HK.02.03/I/0497/2016, 22 Maret 2016

1
HK.02.03/I/0500/2016, 22 Maret 2016

1
HK.02.03/I/0479/2016, 22 Maret 2016

1
HK.02.03/I/0479/2016, 22 Maret 2016

1
HK.02.03/I/0553/2015, 2 Maret 2015

1
17
Nomor SK BENTUK
HK.02.02/I/3216/2017, 24 Juli 2017
HK.02.03/I/0496/2016, 22 Maret 2016

1
HK.02.03/I/0482/2016, 22 Maret 2016

1
HK.02.03/I/0492/2016, 22 Maret 2016

1
HK.02.03/I/2019/2014, 12 Agustus 2014

1
HK.02.03/I/0488/2016, 22 Maret 2016

1
HK.02.03/I/0870/2016, 29 April 2016

1
HK.02.03/I/1146/2016, 25 Mei 2016

1
HK.02.03/I/0520/2016, 28 Maret 2016

1
HK.02.03/I/0913/2016, 4 Mei 2016

1
HK.02.03/I/2696/2016, 5 September 2016

1
HK.02.03/I/0914/2016, 4 Mei 2016

1
HK.02.03/I/3400/2016, 21 Oktober 2016

1
HK.02.03/I/0672/2016, 12 April 2016

1
HK.02.03/I/0517/2016, 28 Maret 2016

1
HK.02.03/I/0915/2016, 4 Mei 2016

1
18
Nomor SK BENTUK
HK.02.03/I/2697/2016, 5 September 2016

1
HK.02.03/I/0869/2016, 29 April 2016

1
HK.02.03/I/1332/2015, 15 Mei 2015

1
HK.02.03/I/2512/2016, 16 Agustus 2016

1
HK.02.03/I/1145/2016, 25 Mei 2016

1
HK.02.03/I/0872/2016, 29 April 2016

1
HK.02.03/I/0609/2016, 7 April 2016

1
HK.02.03/I/0871/2016, 29 April 2016

1
HK.02.03/I/0631/2016, 7 April 2016

1
HK.02.03/I/3405/2016, 21 Oktober 2016

1
HK.02.03/I/3758/2016, 10 Nopember 2016

1
HK.02.03/I/2698/2016, 5 September 2016

1
HK.02.03/I/3218/2017, 24 Juli 2017
19
Nomor SK BENTUK
HK.02.03/I/0483/2016, 22 Maret 2016

1
HK.02.03/I/2211/2015, 31 Juli 2015

1
HK.02.03/I/0490/2016, 22 Maret 2016

1
HK.02.03/I/1144/2016, 25 Mei 2016

1
HK.02.03/I/4126/2016, 6 Desember 2016
HK.02.02/I/2732/2017, 5 Juli 2017
HK.02.02/I/2734/2017, 6 Juli 2017
HK.02.03/I/0522/2016, 28 Maret 2016

1
HK.02.03/I/0498/2016, 22 Maret 2016

1
HK.02.03/I/0484/2016, 22 Maret 2016

1
HK.02.03/I/2860/2016, 9 September 2016

1
HK.02.03/I/1329/2015, 15 Mei 2015

1
HK.02.03/I/1331/2015, 15 Mei 2015 1
20
Nomor SK BENTUK
HK.02.03/I/2699/2016, 5 September 2016

1
HK.02.03/I/0489/2016, 22 Maret 2016 1
HK.02.03/I/2701/2016, 5 September 2016 1
HK.02.03/I/0493/2016, 22 Maret 2016 1
HK.02.02/I/0567/2017, 28 Februari 2017
HK.02.03/I/3220/2017, 24 Juli 2017
HK.02.03/I/0521/2016, 28 Maret 2016 1
HK.02.03/I/0474/2016, 22 Maret 2016

1
HK.02.03/I/1143/2016, 25 Mei 2016

1
HK.02.03/I/3404/2016, 21 Oktober 2016

1
HK.02.03/I/0472/2016, 22 Maret 2016

1
HK.02.03/I/3635/2014, 12 Nov 2014

1
HK.02.03/I/0495/2016, 22 Maret 2016

1
HK.02.03/I/0475/2016, 22 Maret 2016

1
HK.02.03/I/3639/2014, 12 Nov 2016

1
HK.02.03/I/0515/2016, 28 Maret 2016

1
21
Nomor SK BENTUK
HK.02.03/I/0473/2016, 22 Maret 2016

1
HK.02.03/I/0494/2016, 22 Maret 2016

1
HK.02.03/I/0518/2016, 28 Maret 2016

1
HK.02.03/I/0487/2016, 22 Maret 2016

1
HK.02.03/I/0486/2016, 22 Maret 2016

1
HK.02.03/I/0485/2016, 22 Maret 2016 1
HK.02.03/I/0519/2016, 28 Maret 2016
HK.02.03/V.1/3403/2016, 21 Oktober 2016 1
HK.02.03/V.1/0501/2017, 23 Februari 2017
HK.02.03/I/3631/2014, 12 Nov 2014

1
HK.02.02/I/2735/2017, 6 Juli 2017

1
HK.02.02/I/3219/2017, 24 Juli 2017
HK.02.02/I/3221/2017, 24 Juli 2017
22
Nomor SK BENTUK
HK.02.03/I/2214/2015, 31 Juli 2015 1
HK.02.03/I/0499/2016, 22 Maret 2016 1
HK.02.03/I/0481/2016, 22 Maret 2016

1
HK.02.03/I/3633/2014, 14 Nov 2014

1
HK.02.03/I/3632/2014, 12 Nov 2014

1
HK.02.03/I/2212/2015, 31 Juli 2015
HK.02.03/I/0500/2017, 23 Februari 2017
HK.02.02/I/1348/2017, 15 Mei 2017
HK.02.03/I/2213/2015, 31 Juli 2015

1
HK.03.05/I/4163/2015, 28 Sept 2015
HK.02.03/I/0478/2016, 22 Maret 2016

1
HK.02.02/I/2736/2017, 6 Juli 2017
23
Nomor SK BENTUK
HK.02.03/I/0523/2016, 28 Maret 2016
HK.02.03/I/0476/2016, 22 Maret 2016
HK.02.02/I/3217/2017, 24 Juli 2017
HK.02.03/I/0516/2016, 28 Maret 2016

1
27 21 21 12
24

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Lampiran Surat

DAFTAR FASILITAS PELAYANAN KESEHATAN

NO PROVINSI NAMA SARANA KESEHATAN ALAMAT

2 SUMATERA BARAT 1 RSU Pariaman Jl. Prof. M. Yamin SH No. 5, Pariaman

Komplek Taman Niaga Blok J No. 3A dan 5, Sukajadi, Kel. Baloi

7 JAWA BARAT 1 RSUD R. Syamsudin, SH Jl. Rumah Sakit No. 1, Sukabumi.

2 RS Pelabuhan Cirebon Jl. Sisingamangaraja No. 45, Kota Cirebon-45112

8 JAWA TENGAH 1 RSUD Kraton Kab. Pekalongan Jl. Veteran 31 Pekalongan

9 DI YOGYAKARTA 1 RSUD Kota Yogyakarta Jl. Wirosaban No. 1 Yogyakarta

10 JAWA TIMUR 1 RS Blambangan Banyuwangi Jl. Letkol Istglah No. 49 Banyuwangi

2 RSUD Sanjiwani Gianyar Jl. Ciung Wenara No. 2, Gianyar Bali

Jl. Raya Paoq Motong Desa Danger Kec. Masbagik, Lombok

16 KALIMANTAN UTARA 1 RSUD Nunukan Jl. Sungai Fatimah, Nunukan

TELEPON e mail Nomor SK dan Masa Berlaku

(061) 6610072, 6631380 info@rsuimelda.co.id HK.02.03/I/0480/2016, 22 Maret 2019

(061) 4147785, 4147782 mailbox@anugerahibu.com HK.02.03/I/0500/2016, 22 Maret 2019

(061) 4535522, 4510609 medanmedicalcenter@gmail.com HK.02.03/I/1171/2016, 1 Juni 2019

(062 / 061) 4150389, 4524403 sarkesblessing@gmail.com HK.02.03/I/2700/2016, 5 September 2019

(0751) 91118 rsudpariaman_sumbarprov@yahoo.com HK.02.03/I/0497/2016, 22 Maret 2019

(0751)777888/4782990 marketing.semenpadanghospital@gmail.com HK.02.03/I/0500/2016, 22 Maret 2019

(0741) 616921 HK.02.03/I/0479/2016, 22 Maret 2019

(0778) 7372022 Fax. 7372024 operasional@medilab-clinic.com ; customercare@medilab-clinic.com

(0721) 8013567 assalammedical_lampung@yahoo.co.id HK.02.03/I/0553/2015, 2 Maret 2018

(0721) 703312 pelayanan.rsudam@gamil.com HK.02.02/I/3216/2017, 24 Juli 2020

(021) 43938478 rsudkoja@yahoo.com HK.02.03/I/0496/2016, 22 Maret 2019

(021) 8401127 rsudpasarrebo@yahoo.com HK.02.03/I/0482/2016, 22 Maret 2019

(021) 3503150/3842934 info@rstarakanjakarta.com HK.02.03/I/0492/2016, 22 Maret 2019

(021) 87791834 fax. 87791855 afiatmedicalcenter@yahoo.co.id HK.02.03/I/0488/2016, 22 Maret 2019

(021) 8000344, 8017211 info@amaliamedicalcenter.com HK.02.03/I/0870/2016, 29 April 2019

(021) 83792701, 83792702 amanah@medikapura.com HK.02.03/I/1146/2016, 25 Mei 2019

(021) 8307804, 8299132 annur_med@yahoo.co.id HK.02.03/I/0520/2016, 28 Maret 2019

(021) 8190580, 8519038 /8519039 arridhamc@yahoo.com HK.02.03/I/0913/2016, 4 Mei 2019

(021) 8297255, 83791386, 83791518 admin@assaadah-clinic.com HK.02.03/I/2696/2016, 5 September 2019

(021) 83781151/83701152 ar.raudahmedicalcenter@yahoo.com HK.02.03/I/0914/2016, 4 Mei 2019

(021) 80885302, 8092850, 8097584 HK.02.03/I/0672/2016, 12 April 2019

(021) 80883405-06/80883404 dsmc_condet@yahoo.com HK.02.03/I/0517/2016, 28 Maret 2019

(021) 8010318, 80877148 mchaninah@yahoo.co.id HK.02.03/I/0915/2016, 4 Mei 2019

(021) 8353604/83706158 bakthirmc@yahoo.co,id HK.02.03/I/2697/2016, 5 September 2019

(021) 85768013, 85911505, 85911506 insanimc@indosat.net.id HK.02.03/I/0869/2016, 29 April 2019

(021) 8570602, 8570601 mcuhaji@yahoo.com HK.02.03/I/1332/2015, 15 Mei 2018

(021) 8566945, 8508331 nurhuda@cbn.net.id HK.02.03/I/2512/2016, 16 Agustus 2019

(021) 6680843, 6618894 permata_vika2003@yahoo.com HK.02.03/I/1145/2016, 25 Mei 2019

(021) 8301151-52/8292121 rayhanku@gmail.com; rayhanjkt@yahoo.com HK.02.03/I/0872/2016, 29 April 2019

(021) 8291494 Fax 83705327 kliniksetu@yahoo.com HK.02.03/I/2698/2016, 5 September 2019

(021) 4891708 Fax 4711222 info@rsuppersahabatan.co.id HK.02.03/I/3218/2017, 24 Juli 2020

(0231) 323100 rsmitraplumbon@yahoo.com HK.02.03/I/0490/2016, 22 Maret 2019

(0231) 232717/220258 saadahcirebon@yahoo.com HK.02.03/I/1144/2016, 25 Mei 2019

(0231) 661126 brsud.waled@gmail.com HK.02.03/I/4126/2016, 6 Desember 2019

(0234) 272655 rsudkabindramayu@yahoo.co.id HK.02.02/I/2732/2017, 5 Juli 2020

(0285) 421621 rsudkraton@yahoo.co.id HK.02.03/I/0522/2016, 28 Maret 2019

(0282) 534144, 534646 cilacap@annurmedical.com HK.02.03/I/0498/2016, 22 Maret 2019

(0281) 621829 annurpwt@yahoo.com HK.02.03/I/0484/2016, 22 Maret 2019

(0271) 648026 info@budisehat.com HK.02.03/I/2860/2016, 9 September 2019

(0294) 3689949 Fax. 383223 centrumkendal@yahoo.com HK.02.03/I/1329/2015, 15 Mei 2018

(024) 7614767 Fax. 7626567 centrumsmg@yahoo.com HK.02.03/I/1331/2015, 15 Mei 2018

(024) 3553188/3562595 ibl_klinik@yahoo.com HK.02.03/I/2699/2016, 5 September 2019

(024) 8412270 klinikutamapermata@yahoo.co.id HK.02.03/I/0489/2016, 22 Maret 2019

(0295) 386111 keluargasehat.pati@gmail.com HK.02.03/I/2701/2016, 5 September 2019

(024) 7612920 ultramedica@yahoo.com HK.02.03/I/0493/2016, 22 Maret 2019

(0286) 324262 fax. 324430 annurwonosobo@gmail.com HK.02.02/I/0567/2017, 28 Februari 2020

(0294) 381444 www.rsudkendal.com HK.02.03/I/3220/2017, 24 Juli 2020

(0274) 371195 rsud@jogjakarta.go.id HK.02.03/I/0521/2016, 28 Maret 2019

(0274) 452166 annuryog@yahoo.com HK.02.03/I/0474/2016, 22 Maret 2019

(0274) 370360 ultramedyogya10212@yahoo.com HK.02.03/I/1143/2016, 25 Mei 2019