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No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails DENPASAR 1 0870 RSU. KERTHA USADA JL. CENDRAWASIH, NO.57, SINGARAJA BPK.PUTU WILANTARI /SYLVIE YULIASARI B.BUS MARKETING 0362-26277/8| 0362-22741 Y Y Y ACTIVE ALL COVERAGE [email protected] 2 1451 RSU. PARAMA SIDHI JL. A.YANI NO.171A BPK. DERMAWAN/ IBU SUCI MARKETING 0362-29787, 32701,22426,| 0362-29787 Y Y Y ACTIVE ALL COVERAGE [email protected] DENPASAR 3 1047 RS. BALI MEDISTRA ( BALIMED ) JL. MAHENDRADATTA, NO.57X, DENPASAR BPK KRISNA Marketing 0361-484748, 482281,8450771, 8450772| 0361- 8450773,8450770 Y Y Y ACTIVE ALL COVERAGE marketing_balimedhospital@yah oo.com 4 0864 KLINIK & APOTEK KF 34 DENPASAR JL. DIPONEGORO NO.125, DENPASAR BPK WISMAYA KOORDINATOR 0361-225555/227811-12-|- 0361-223433 N Y Y PARTIAL GP,SP,OP,DENTAL,LAB,RM-RI,RM- RJ,RM-RG,RM-KM,RM-RB,PHAR [email protected] 5 3455 APOTIK KIMIA FARMA NO.66 PATIMURA JL. PATIMURA NO.59 DENPASAR - - 0361-234797| - N Y Y PARTIAL GP,SP,OP,DENTAL,LAB,RM-RI,RM- RJ,RM-RG,RM-KM,RM-RB,PHAR [email protected] 6 2599 KLINIK & APOTEK KF 82 JL. KARTIKA PLAZA, NO.67, KUTA-BALI DRS. SANGKAN MULYANTO ,APT - 0361 757196| N Y Y PARTIAL GP,SP,OP,DENTAL,LAB,RM-RI,RM- RJ,RM-RG,RM-KM,RM-RB,PHAR - 7 2600 KLINIK & APOTEK KF 236 JL. DANAU BATUR RAYA, TM GRIYA, JIMBARAN DRS. AJI PAMUNGKAS,APT - 0361 8479785| - N Y Y PARTIAL GP,SP,OP,DENTAL,LAB,RM-RI,RM- RJ,RM-RG,RM-KM,RM-RB,PHAR - 8 1150 RSIA. PURI BUNDA JL. GATOT SUBROTO VI, NO.19 IBU ONI / LIRA MARKETING 0361-437999| 0361-433988 Y Y Y ACTIVE ALL COVERAGE [email protected]/dek_onik@ yahoo.co.id 9 1245 RSU. SURYA HUSADHA UBUNG JL. COKROAMINOTO, NO.356, DENPASAR KARMILA DEWI MARKETING 0361-425744| 0361-430557 Y Y Y ACTIVE ALL COVERAGE - 10 1202 KLINIK MERDEKA MEDICAL CENTER (MMC) MERDEKA VIII/2 TANJUNG BUNGKAK- DENPASAR I KETUT SUSANA - 0361-233790| - N Y Y PARTIAL GP,SP,OP,DENTAL,LAB,RM-RI,RM- RJ,RM-RG,RM-KM,RM-RB,PHAR [email protected] 11 1273 RS. SURYA HUSADHA JL. PULAU SERANGAN,NO.7, DENPASAR KARMILA DEWI MARKETING 0361-233787| 0361-231177 Y Y Y ACTIVE ALL COVERAGE marketingsuryahusadha@gmail. com; 12 1309 BALI ROYAL HOSPITAL ( BROS ) JL. TANTULAR NO 6 RENON DENPASAR IBU LILIK SHANTINI MARKETING 0361- 247499/222588| 0361- 226051/226052 Y Y Y ACTIVE ALL COVERAGE [email protected] 13 1146 RSU. BHAKTI RAHAYU DENPASAR JL. GATOT SUBROTO II, NO.11 BPK BAGUS MARKETING 0361- 430270,430245,7420673| 0361-263371 Y Y Y ACTIVE ALL COVERAGE [email protected] 14 1463 KLINIK PENTA MEDIKA JL. TEUKU UMAR BARAT- MARLBORO,NO.88 DR.SATRY WIBAWA CLINIC MANAGER 0361-7446144/490709| 0361 - 490708 N Y Y PARTIAL GP,SP,OP,DENTAL,LAB,RM-RI,RM- RJ,RM-RG,RM-KM,RM-RB,PHAR [email protected]/billing @pentamedica.com 15 0220 RS. PRIMA MEDIKA JL. PULAU SERANGAN, 9X DR.DIAN EKAWATI MARKETING 0361 - 236225/257445| 0361- 236203/262535 Y Y Y ACTIVE ALL COVERAGE [email protected] om 16 0179 RSU. KASIH IBU DENPASAR JL. TEUKU UMAR, NO.120 IBU EKA MARKETING 0361- 223036/3003030/08214680 6677| 0361-238690 Y Y Y ACTIVE ALL COVERAGE [email protected] 17 0140 RS. MANUABA JL. HOS. COKROAMINOTO, NO.28 BPK. GEDE / IBU LODE KEUANGAN 0361-426393| 0361- 285183/429447 Y Y Y ACTIVE ALL COVERAGE [email protected]/manua [email protected] 18 0221 RS. PURI RAHARJA JL. WR.SUPRATMAN, NO.14-19, DENPASAR IBU.I NYOMAN MARKETING 0361-222013| 0361-242537 Y Y Y ACTIVE ALL COVERAGE [email protected] 19 0867 KIMIA FARMA HEALTHCARE - DENPASAR JL. DIPONEGORO NO.125, DENPASAR IBU NI KADEK BAGIANI KOORDINATOR 0361-255914-|- 0361-255914 N Y Y PARTIAL GP,SP,OP,DENTAL,LAB,RM-RI,RM- RJ,RM-RG,RM-KM,RM-RB,PHAR [email protected] / [email protected] GIANYAR 20 1761 RS. ARI CANTI GIANYAR JL. RAYA MAS UBUD GIANYAR DR. IKA / NGURAH MARKETING 0361-974573| 0361-974573 Y Y Y ACTIVE ALL COVERAGE [email protected] 21 3549 RSU. SANJIWANI GIANYAR JL. CIUNG WANARA N0.2 GIANYAR WAYAN KASUBID UMUM 0361-943049| Y Y Y ACTIVE ALL COVERAGE [email protected] 22 4075 RSU. PREMAGANA JL. HAYANG SANGSI NO.2 PERUM CHANDRA AYU, BANJAR TUBUH, BATU BULAN - SUKAWATI AGUNG BRAHMA / KADEK MARKETING 0361-296328/ 296389 / 082144049401| 0361-295246 Y Y Y ACTIVE ALL COVERAGE [email protected] KARANGASEM 23 2301 KLINIK PENTA MEDICA CANDIDASA JL. RAYA MANGGIS NO. 88, KAB. KARANGASEM, BALI BPK DEDI - 0363-41909| - N Y Y PARTIAL GP,SP,OP,DENTAL,LAB,RM-RI,RM- RJ,RM-RG,RM-KM,RM-RB,PHAR - 24 4252 RS. BALIMED KARANGASEM JL. NENAS KECICANG BEBANDEM, KARANGASEM, BALI CRISTIN CAROLINA (082236282821 - (0363) 4301618| Y Y Y ACTIVE ALL COVERAGE marketing.rsbalimedkarangasem @gmail.com KLUNGKUNG 25 1893 RS. BINTANG JL. NGURAH RAI NO. 36 KLUNGKUNG - BALI IBU ARI MARKETING 0366-25241| - Y Y Y ACTIVE ALL COVERAGE - KUTA 26 1492 KLINIK KASIH IBU KOMPLEKS PERUM BUMI DALUNG PERMAI, BLOK C1-C4 IBU PUTRI/YANTI MARKETING 0361-422150| 0361-422179 N Y Y PARTIAL GP,SP,OP,DENTAL,LAB,RM-RI,RM- RJ,RM-RG,RM-KM,RM-RB,PHAR [email protected] 27 1138 RSU. KASIH IBU KEDONGANAN JL. ULUWATU, NO.69A, KEDONGANAN IBU FRISA MARKETING 0361-703270| 0361-703329 Y Y Y ACTIVE ALL COVERAGE frisa.andarina@kasihibuhospital. com LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015 KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP BALI LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 1 14/08/2015

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No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

DENPASAR

1 0870 RSU. KERTHA USADA JL. CENDRAWASIH, NO.57, SINGARAJA

BPK.PUTU

WILANTARI /SYLVIE

YULIASARI B.BUS

MARKETING 0362-26277/8| 0362-22741 Y Y Y ACTIVE ALL COVERAGE [email protected]

2 1451 RSU. PARAMA SIDHI JL. A.YANI NO.171ABPK. DERMAWAN/

IBU SUCIMARKETING 0362-29787, 32701,22426,| 0362-29787 Y Y Y ACTIVE ALL COVERAGE [email protected]

DENPASAR

3 1047 RS. BALI MEDISTRA ( BALIMED )JL. MAHENDRADATTA, NO.57X,

DENPASARBPK KRISNA Marketing

0361-484748,

482281,8450771, 8450772|

0361-

8450773,8450770Y Y Y ACTIVE ALL COVERAGE

marketing_balimedhospital@yah

oo.com

4 0864 KLINIK & APOTEK KF 34 DENPASAR JL. DIPONEGORO NO.125, DENPASAR BPK WISMAYA KOORDINATOR 0361-225555/227811-12-|- 0361-223433 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

5 3455APOTIK KIMIA FARMA NO.66

PATIMURAJL. PATIMURA NO.59 DENPASAR - - 0361-234797| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

6 2599 KLINIK & APOTEK KF 82 JL. KARTIKA PLAZA, NO.67, KUTA-BALIDRS. SANGKAN

MULYANTO ,APT- 0361 757196| N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

7 2600 KLINIK & APOTEK KF 236JL. DANAU BATUR RAYA, TM GRIYA,

JIMBARAN

DRS. AJI

PAMUNGKAS,APT- 0361 8479785| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

8 1150 RSIA. PURI BUNDA JL. GATOT SUBROTO VI, NO.19 IBU ONI / LIRA MARKETING 0361-437999| 0361-433988 Y Y Y ACTIVE ALL [email protected]/dek_onik@

yahoo.co.id

9 1245 RSU. SURYA HUSADHA UBUNGJL. COKROAMINOTO, NO.356,

DENPASARKARMILA DEWI MARKETING 0361-425744| 0361-430557 Y Y Y ACTIVE ALL COVERAGE -

10 1202KLINIK MERDEKA MEDICAL CENTER

(MMC)

MERDEKA VIII/2 TANJUNG BUNGKAK-

DENPASARI KETUT SUSANA - 0361-233790| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

11 1273 RS. SURYA HUSADHA JL. PULAU SERANGAN,NO.7, DENPASAR KARMILA DEWI MARKETING 0361-233787| 0361-231177 Y Y Y ACTIVE ALL COVERAGEmarketingsuryahusadha@gmail.

com;

12 1309 BALI ROYAL HOSPITAL ( BROS ) JL. TANTULAR NO 6 RENON DENPASAR IBU LILIK SHANTINI MARKETING 0361- 247499/222588|0361-

226051/226052Y Y Y ACTIVE ALL COVERAGE [email protected]

13 1146 RSU. BHAKTI RAHAYU DENPASAR JL. GATOT SUBROTO II, NO.11 BPK BAGUS MARKETING0361-

430270,430245,7420673|0361-263371 Y Y Y ACTIVE ALL COVERAGE [email protected]

14 1463 KLINIK PENTA MEDIKAJL. TEUKU UMAR BARAT-

MARLBORO,NO.88DR.SATRY WIBAWA CLINIC MANAGER 0361-7446144/490709| 0361 - 490708 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]/billing

@pentamedica.com

15 0220 RS. PRIMA MEDIKA JL. PULAU SERANGAN, 9X DR.DIAN EKAWATI MARKETING 0361 - 236225/257445|0361-

236203/262535Y Y Y ACTIVE ALL COVERAGE

[email protected]

om

16 0179 RSU. KASIH IBU DENPASAR JL. TEUKU UMAR, NO.120 IBU EKA MARKETING

0361-

223036/3003030/08214680

6677|

0361-238690 Y Y Y ACTIVE ALL COVERAGE [email protected]

17 0140 RS. MANUABA JL. HOS. COKROAMINOTO, NO.28BPK. GEDE / IBU

LODEKEUANGAN 0361-426393|

0361-

285183/429447Y Y Y ACTIVE ALL COVERAGE

[email protected]/manua

[email protected]

18 0221 RS. PURI RAHARJAJL. WR.SUPRATMAN, NO.14-19,

DENPASARIBU.I NYOMAN MARKETING 0361-222013| 0361-242537 Y Y Y ACTIVE ALL COVERAGE [email protected]

19 0867KIMIA FARMA HEALTHCARE -

DENPASARJL. DIPONEGORO NO.125, DENPASAR

IBU NI KADEK

BAGIANIKOORDINATOR 0361-255914-|- 0361-255914 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected] /

[email protected]

GIANYAR

20 1761 RS. ARI CANTI GIANYAR JL. RAYA MAS UBUD GIANYAR DR. IKA / NGURAH MARKETING 0361-974573| 0361-974573 Y Y Y ACTIVE ALL COVERAGE [email protected]

21 3549 RSU. SANJIWANI GIANYAR JL. CIUNG WANARA N0.2 GIANYAR WAYAN KASUBID UMUM 0361-943049| Y Y Y ACTIVE ALL COVERAGE [email protected]

22 4075 RSU. PREMAGANA

JL. HAYANG SANGSI NO.2 PERUM

CHANDRA AYU, BANJAR TUBUH, BATU

BULAN - SUKAWATI

AGUNG BRAHMA /

KADEKMARKETING

0361-296328/ 296389 /

082144049401|0361-295246 Y Y Y ACTIVE ALL COVERAGE [email protected]

KARANGASEM

23 2301 KLINIK PENTA MEDICA CANDIDASAJL. RAYA MANGGIS NO. 88, KAB.

KARANGASEM, BALIBPK DEDI - 0363-41909| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

24 4252 RS. BALIMED KARANGASEMJL. NENAS KECICANG BEBANDEM,

KARANGASEM, BALI

CRISTIN CAROLINA

(082236282821- (0363) 4301618| Y Y Y ACTIVE ALL COVERAGE

marketing.rsbalimedkarangasem

@gmail.com

KLUNGKUNG

25 1893 RS. BINTANGJL. NGURAH RAI NO. 36 KLUNGKUNG -

BALIIBU ARI MARKETING 0366-25241| - Y Y Y ACTIVE ALL COVERAGE -

KUTA

26 1492 KLINIK KASIH IBUKOMPLEKS PERUM BUMI DALUNG

PERMAI, BLOK C1-C4IBU PUTRI/YANTI MARKETING 0361-422150| 0361-422179 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

27 1138 RSU. KASIH IBU KEDONGANAN JL. ULUWATU, NO.69A, KEDONGANAN IBU FRISA MARKETING 0361-703270| 0361-703329 Y Y Y ACTIVE ALL COVERAGEfrisa.andarina@kasihibuhospital.

com

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 1 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI28 0875 KLINIK MANUABA JL. RAYA KUTA - TUBAN DR.FAJAR MANUABA KOORDINATOR 0361-754748| 0361-227228 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]/manua

[email protected]

29 1909 SILOAM HOSPITALS BALI JL. SUNSET ROAD NO. 818, KUTA IBU NETTY Marketing 0361-779900| 0361-779933 Y Y Y ACTIVE ALL [email protected]

om

NUSA DUA

30 1359 RSU. SURYA HUSADHA NUSA DUA JL. SILIGITA, BLOK 1, NO.14 KARMILA DEWI MARKETING 0361-775827| 0361-771388 Y Y Y ACTIVE ALL COVERAGE -

31 2603 KLINIK & APOTEK KF 126JL. BY PASS NGURAH RAI NO 890,NUSA

DUA

DRS. AJI

SUTARMAJI,APT- 0361 778555| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

32 0222 KLINIK PRIMA MEDIKAJL. BY PASS NGURAH RAI, PERTOKOAN

NIAGA, NO.81

IBU LUH GEDE

DARWATIKOORDINATOR 0361-770509| 0361-770509 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

SANUR

34 1248 KLINIK REMEDIUM CARE JL. BY PASS NGURAH RAI NO.243 IBU DELLA DIREKTUR 0361-288860| 0361-287970 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

TABANAN

35 1714 RS. WISMA PRASANTIJL. YAH GANGGA NO. 9 TABANAN ,

BALI

BPK AGUNG MAYUN/

DR. IGE RAY WIJAYA

MARKETING/Direkt

ur0361-8043219/810555| 0361-812454 Y Y Y ACTIVE ALL COVERAGE [email protected]

36 2133 RSU. KASIH IBU TABANANJL. FLAMBOYAN NO. 9 ( KAMPUNG

KODOK )DR. BOANA MARKETING 0361-3005757| 0361-3005758 Y Y Y ACTIVE ALL COVERAGE [email protected]

37 3456APOTIK & KLINIK KIMIA FARMA.102

TABANANJL. NGURAH RAI NO.74 A TABANAN - - 0361-810524| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

UBUD

38 0224 UBUD CLINICJL. TJAMPUHAN, NO.36, P.O.BOX 10,

UBUD, GIANYAR

DR.I.WAYAN

SUANDHI ARYANA/

AGUNG

KOORDINATOR 0361-974911| 0361-974910 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

BANGKA INDUK

39 2148 RS. ARSANIJL. RAYA AIR KENANGA KEC. SUNGAI

LIAT KAB. BANGKA BLITUNGIBU IRNA RAWATI MARKETING 0717-4297825, 4297834| 0717-4297824 Y Y Y ACTIVE ALL COVERAGE [email protected]

BELITUNG

40 1928 KLINIK UTAMA BELITUNGJL. MERDEKA NO. 27 TANJUNGPANDAN

BELITUNGIBU ETA MARKETING 0719-25526| 71925600 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

PANGKAL PINANG

41 1443 RS. KHATOLIK BHAKTI WARA JL. SUNGAI SELAN, KM.4, NO.180 BPK.OCTAVIANUS Marketing 0717-422605| 0717-424314 Y Y Y ACTIVE ALL [email protected];rsk_

[email protected]

42 1508 RS. MEDIKA STANNIAJL. JEND.SUDIRMAN, NO.3, SUNGAI

LIAT

IBU LIA/ BP BUDI/

IBU RIDAADMINISTRASI 0717-95837/93335| 0717-953335 Y Y Y ACTIVE ALL COVERAGE [email protected]

43 0900 SUN CLINICEL-JOHN PLAZA, JL. SUKARNO HATTA,

NO.208DIAH KOORDINATOR 0717-4297888-|- 0717-439488 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

44 1230 RS. BAKTI TIMAH PANGKAL PINANGJL. BUKIT BARU NO.1 PANGKAL

PINANGBP HERI MARKETING 0717-421091| 0717-424212 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

CILEGON

45 0995 KLINIK & APOTIK WARINGINJL. RAYA WARINGIN KURUNG SERDANG

SERANGDR MONITA / DIANA koordinator

0254-

310609/085215480711-|-- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

46 1943 KLINIK MUTIARA BUNDA JL. S.A TIRTAYASA NO. 86, CILEGON - - 0254-399968|0254-

399989/376454N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

47 1815 KLINIK INSAN PRIMARUKO CILEGON CITY SQUARE BLOK I-8,

CILEGONDRG. LUSI Owner 0254-393 197| N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

48 2780 KLINIK GRIYA SEHAT

PERUMAHAN GRIYA CILEGON BLOK D6-

7 KEL.WARINGIN KURUNGI,

KEC.KRAMATWATU 42161

DR.RETNO Pemilik/Finance 0254-388501| 0254-388501 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

49 4327 KLINIK ISNA MEDIKA

JL. RAYA MERAK KM.8 KESERANGAN

KEL. RAWA ARUM KEC. GROGOL,

CILEGON, BANTEN

- - 0254-573756| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

50 0915 RS. KRAKATAU MEDIKA JL. SEMANG RAYA - CILEGON IBU YATI MARKETING0254-3963330254-

372123|0254-372123

0254-

391972/374010Y Y Y ACTIVE ALL COVERAGE

[email protected]/ruhiyat@rskmd

.com

51 0939 RSIA. MUTIARA BUNDA CILEGONJL. SA TIRTAYASA RUKO MAISONETTE

BLOK B 1-2 SIMPANG TIGA CILEGONBPK.RIFAI MARKETING

0254-

399988/376888/399968-|-0254-376454 Y Y Y ACTIVE ALL COVERAGE

[email protected]

d/@ymail.com

52 0121 KLINIK AMALIA JL. S.A TIRTAYASA NO.7BPK MAKHBUD

NAHDIADMINISTRASI 0254-391307-|- 0254-391307 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

BANGKA BELITUNG

BANTEN

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 2 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI53 0057 KLINIK ALFINA

RUKO PONDOK CILEGON INDAH, BLOK

KK1, NO.7-8BIDAN ATUL/ERNA KEUANGAN 0254-383116| 0254-377377 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

54 0129 APOTIK LABORA FARMA JL. ALUN-ALUN UTARA, NO.23DR. BUI MIN / DR.

MERRY CHANDRAKEUANGAN 0254-391695| 0254-374278 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

55 2335 KLINIK EDI MEDIKARUKO EDI TOSERB. A, JL. RAYA MERAK

88 CILEGON, BANTEN 42431IBU DIAN KOORDINATOR 0254-383080| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

56 0951 KLINIK & APOTEK KF 140 JL. S.A. TIRTAYASA NO 12 DR AGUS CAHYANA KOORDINATOR 0254-392278-|- 0254-399173 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

57 0985 RSIA. KURNIA CILEGON JL. JOMBANG MASJID NO.4 IBU.TRI MARKETING 0254-391161|-0254-

396489,397023Y Y Y ACTIVE ALL COVERAGE

[email protected]/

[email protected]

58 1254 RB & KLINIK AFINAJL. RAMBUTAN 12, PAGEBANGAN -

CILEGONIBU DESI PENGELOLA 0254-392568| 0254-392568 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

59 1403 KLINIK KELUARGA PULO AMPELJL. SALIRA INDAH DS.SUMURANJA

PULOAMPELDR. RACHMI Pimpinan

0254-5751100 / 0254 -

572100|0254-5751100 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

60 1536 KLINIK & APOTIK KOTA BAJA JL. S.A. TIRTAYASA, NO.115BPK.SYAHRIZAL/IBU

OPIKOORDINATOR 0254-391822|

0254-

392346/391822N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

61 1298 KLINIK IKHLAS MEDIKA IVPONDOK CILEGON INDAH ( PCI ) BLOK

A 19/10 CILEGONDR. TETI ENDRIANI - 0254-7061935| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

62 0302 KLINIK ANANDA CILEGON JL. R. SUPRAPTO KM.8DR. MOCH.

PROKOSOKEUANGAN 0254-310609| 0254-310821 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

63 0320 KLINIK BONA MEDIKAFESTIVAL RUKO, BLOK B10-11,

BONAKARTADRG. ANE MARKETING 0254-387684| 0254-386699 N Y Y ACTIVE ALL COVERAGE [email protected]

64 0595APOTIK & KLINIK PRIMA HUSADA

CILEGON

RUKO CILEGON CITY SQUARE (

SAMPING GIANT-PCI) BLOK B3;5 E3;5IBU IDA

MARKETING/KEUA

NGAN

0254 - 399933/3998560254

- 391677|0254 - 3916770254-399928 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

PANDEGLANG

65 1764 KLINIK ALFURQONJL. RAYA LABUAN KM 2 TOROGONG

MARGASANA - PANDEGLANG

IBU ELIS / DR

FURQON

KEUANGAN /

PEMILIK0253-803777| 0253-501313 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

66 0997 KLINIK DIFFAJL. RAYA LAB. UAN KM.12 CIPUTRI

MENESBPK DIDI/ HERRY PEMILIK/ADMIN 0253-502161-|- 0253-502160 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

RANGKASBITUNG67 1084 RS. MISI LEBAK JL. MULTATULI NO.41 IBU YENI MARKETING 0252-201014-|- 0252-203390 Y Y Y ACTIVE ALL COVERAGE [email protected]

68 0658 KLINIK SEHAT RABINZAJL. HADIWINANGUN, PERTOKOAN

RABINZA, BLOK B1-2IBU MURTINI KOORDINATOR 0252-280023| 0252-280023 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

69 3141 KLINIK DAN APOTEK MEDIKAJL. AHMAD YANI RANCASEMA -

RANGKASBITUNG, BANTENDR. DIANA - 0252-209975| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

SERANG

70 2413 KLINIK ANDRI MEDISTRAJL. N. RAYA SERANG JAKARTA KM 8

CIRUAS, SERANG - BANTENDR. ANDRI PEMILIK -| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

71 2726 KLINIK & APOTEK KF 253JL. YUSUF MARTADILAGA NO. 114

SERANG- BANTEN- - 0254-211447| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

72 2414 KLINIK JANNAHJL. KH.ABDUL HADI NO.13 KEBUN JAHE

SERANG, KAB.BANTENDR JANNAH - 0254-209321| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

73 3993 RS. KURNIA SERANGJL. RAYA CILEGON KM.8, DESA

KRAMATWATU SERANG - BANTENIBUTRI RAHMISIVA - 0254-232648| 0254-8235050 Y Y Y ACTIVE ALL COVERAGE [email protected]

74 3985 KLINIK & APOTEK MURASAKI MEDIKAKOMP.PEJATEN MAS BLOK C/1 PEJATEN

KEC.WATU-BANTENDR.WARIH ANJANI - 0254233317| - N Y Y ACTIVE ALL COVERAGE [email protected]

75 2392 KLINIK & APOTIK BONA SERANGJL. RAYA SERANG - CILEGON RUKO

LEGOK SUKMAJAYA NO. 5A1 SERANGBPK HERI - 0254-228005/ 287684| 0254-205906 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

76 2336 KLINIK TIARA DENTAL

JL. RAYA WARINGIN KURUNG, RUKO

NUSA RESIDENCE KAV.R NO.19 DESA

MARGATANI KEC. KRAMATWATU,

SERANG

BPK AGUS KOORDINATOR 0254-8482203| 0254-5751349 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

77 2608 KLINIK & APOTEK KF SERANG BARU JL. AHMAD YANI NO. 57,SERANGNURUL FAHMI

HAYATI,S.FAR, APT- 0254 211065| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

78 0984 KLINIK CIJAWA MEDIKA JL. KH. A. FATAH HASAN NO.8 DR. L. P. PIRGAYANI KOORDINATOR0254-204735 /

08128521336-|-0254-204735 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

79 1126 KLINIK KRAKATAU MEDIKA SERANGJL. TB SUWANDI, KAV KEMUNING NO. 1

LINGKAR SELATAN KEC SERANGIBU NINA

PENANGGUNG

JAWAB0254-204407| 0254-221397 N Y Y ACTIVE ALL COVERAGE [email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 3 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI80 1414 RSIA. PURI GRACIA

JL. GRIYA PURNAMA NO 99 TEGAL

PADANG LEGOK, SERANG BANTEN

42162

BPK. HANS MARKETING 0254-223333| 0254-223786; Y Y Y ACTIVE ALL COVERAGE [email protected]

81 1272 RS. SARI ASIH SERANGJL. JEND.SUDIRMAN, NO.38,

PENANCANGAN, CIPOCOK

BPK.AGUNG/BPK.SA

HRULMARKETING 0254-220022| 0254-220345 Y Y Y ACTIVE ALL COVERAGE

[email protected]/aramda

[email protected]

82 1489RS. HERMINA CIRUAS (D/H RS.

CITRA MEDIKA CIRUAS

JL. RAYA SERANG KM.9 DS.RANJENG -

CIRUASIBU ENENG Marketing 0254-281829| 0254-281845 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

83 0716 RSIA. BUDI ASIH JL. K.H. SOHARI, NO.39

IBU HELMI

APRIANTI/ BPK.

ZULKIFLI

MARKETING 0254-212484| 0254-208583 Y Y Y ACTIVE ALL [email protected];

[email protected]

84 0115 KLINIK SERANG MEDIKAJL. RAYA SERANG CILEGON RUKO

LEGOK SUKMAJAYA BLOK 5C NO.1DR. SYAMSIR KEUANGAN 0254-223992| 0254-223992 N Y Y ACTIVE ALL COVERAGE [email protected]

85 1004 KLINIK WISATA MEDIKA JL. RAYA ANYER NO.9DR SUTADI / IBU

ENDANGKOORDINATOR

0254-600933/605141/

081905180805-|-0254-605141 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

86 1008 KLINIK IKHLAS MEDIKA 1KOMPLEK BUMI AGUNG PERMAI 1,NO.

DI/6DR. TETI ENDRIANI

PENANGGUNGJAW

AB0254-207918-|- 0254-281676 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

87 1009 KLINIK IKHLAS MEDIKA 2JL. RAYA SERANG - JAKARTA (DEPAN

KAMPUS UNTIRTA)

DR.TETI ENDRIANI /

BPK AHMAD

PENANGGUNGJAW

AB /ADM0254-284937-|- - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

88 0937 KLINIK MODERN MEDIKA CIKANDEJL. RAYA SERANG KM.68 RUKO B6

CIKANDE SERANGIBU.ARINDA KOORDINATOR 0254-400554-|- 0254-400556 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

[email protected]

89 0941 KLINIK MODERN MEDIKA KRAGILANJL. RAYA SERANG KM15 RUKO D9

KRAGILANIBU AIDA KOORDINATOR 0254-281720-|- 0254-281720 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

TANGERANG

90 0872RB & KLINIK MUTIARA OBBINI

MEDIKA

JL. RAYA KRESEK NO.27, DS.MERAK,

BALARAJABPK BAHTIAR PENGELOLA 021- 59431110-|- 021-59430131 N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]/

[email protected]

91 1014 RB & KLINIK PERMATA - DR JAMILAHJL. NUSA INDAH I, BLOK A7 NO.1,

PERUM. CIBODAS

DR JAMILAH / IBU

LINDAPEMILIK KLINIK 021-5533314| 021-5533314 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected];

[email protected]

92 1020 RSIA. SELARAS CIKUPAJL. RAYA SERANG KM.18,5 DS BOJONG,

CIKUPABPK ERICK MARKETING 021-5969145/59401289| 021-59401277 Y Y Y ACTIVE ALL COVERAGE [email protected]

93 1025 RS. ARIYA MEDIKAJL. INDUSTRI RAYA 1, BLOK A, NO.1-6,

JATAKEIBU ANI MARKETING 021-5902229/5902232-|-

021-

5902223/5904951Y Y Y ACTIVE ALL COVERAGE [email protected]

94 0936 RS. SARI ASIH CILEDUGJL. HOS COKROAMINOTO NO.38

CILEDUGIBU INDRI/NOVISA MARKETING

021-7333430/ 33553359021-

7332758|021-7332758021-7333441 Y Y Y ACTIVE ALL COVERAGE [email protected]

95 0942 RSIA. MURNI ASIHJL. RAYA BOJONGNANGKA NO 86,

MEDANG, PAGEDANGAN TANGERANG

IMANUEL AGANDA

PURB. ADIREKTUR

021-

36868757/5470263/542009

82/5463672021-

5463755|021-5463755

021-54204504 Y Y Y ACTIVE ALL COVERAGE [email protected]

96 1046 RSIA. PRATIWI JL. RHM NOERADJI, NO.42, KARAWACIDR YUNITA/ BP

NANANGMARKETING

021-5520692/71342783021-

43933978|021-43933978021-5224139 Y Y Y ACTIVE ALL COVERAGE [email protected]

97 1049 KLINIK SELARAS

JL. RAYA SERPONG BSD SEKTOR

IV,RUKO E.NO.43-45 SERPONG-

TANGERANG

IBU YUNIMARKETING/PENA

GIHAN021-5370311-|- 021-5377842 N Y Y ACTIVE ALL COVERAGE [email protected]

98 2337 KLINIK TUMBURJL. PAHLAWAN NO.4 SITUGINTUNG

REMPOA CIPUTAT TIMUR

DRG. ELISABET

SIBURIAN- 0217492818| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

99 2347 RS. PERMATA PAMULANGJL. RAYA SILIWANGI NO. 1A,

PAMULANG TANGERANGRIFIFI MAHESWARI MARKETING 021-74704999/74709079| - Y Y Y ACTIVE ALL COVERAGE

rspermatapamulangmarketing@

gmail.com

100 2609 KLINIK & APOTEK KF BERINGINJL. BERINGIN RAYA NO.45, KARAWACI,

TANGERANG

WIDYOWATI ISTI

KUSUMADEWI,S.FA

RM, APT

- 021 55763538| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

101 2469 KLINIK PRATAMAJL. CIRARAB RAYA NO.61 KEC. LEGOK

TANGERANG - BANTEN- - 021- 54260359| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

102 1646 KLINIK JATI ELOK

KOMP. BUMI JATI ELOK BLOK A I NO 7,

JL. RAYA LEGOK-PARUNG PANJANG KM.

3,MALANGNENGAH, PAGEDANGAN,

TANGERANG, BANTEN

BP BUDI MULYONO MARKETING 021-98496234| 021-5977529 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

103 2504 RS. HERMINA SERPONGJL. RAYA PUSPITEK KM.8 NO.99,

SERPONG, TANGERANG SELATAN-DR DIAN CANDRA marketing (021) 7588 4999| 021 - 75883704 Y Y Y ACTIVE ALL COVERAGE

serpong@herminahospitalgroup.

com

104 2774 RSIA. INSAN PERMATA

JL. BHAYANGKARA 1 NO.68 KEL.

PAKUJAYA, KEC. SERONG UTARA -

TANGERANG SELATAN

PAK SOFYAN - 021-53121344| 021-5396733 Y Y Y ACTIVE ALL COVERAGE [email protected]

105 1168 RSU. BHAKTI ASIHJL. RADEN SALEH, NO.10, KARANG

TENGAH

DRA. SUSI

KURNIASIH / IBU

SUSI

MARKETING021-7305662/63/021-

32575495|

021-

73449491/730565

2

Y Y Y ACTIVE ALL COVERAGE [email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 4 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI106 0971 RS. ISLAM ASSHOBIRIN

JL. RAYA SERPONG KM.11 PONDOK

JAGUNG - SERPONGIBU NENENG MARKETING

021-5384314021-

5374293|021-5374293

021-

5374392/5374294Y Y Y ACTIVE ALL COVERAGE [email protected]

107 1113 MEDIPRO CLINIC CITRA RAYA

JL. BOULEVARD PERUM CITRA RAYA,

RUKO ETERNITY, BLOK KF 01 NO 8-10.

KAWASAN MARDIGRAS

IBU ANDAR MARKETING 021-29003558/9| 021-29003556 N Y Y ACTIVE ALL [email protected]

o.id

108 1116RS. AWAL BROS TANGERANG (D/H

RS. GLOBAL MEDIKA

JL. MH.THAMRIN NO.3 KEBON NANAS -

CIKOKOLIBU PITRI/IBU MERY MARKETING 021-55780888/55781234| 021-55781545 Y Y Y ACTIVE ALL COVERAGE [email protected]

109 1223 EKA HOSPITAL BSDCENTRAL BUSINESS DISTRICT, LOT IX,

BSD CITYIBU. INEZ/ AJI MARKETING 021-25655555| 021-25655544 Y Y Y ACTIVE ALL COVERAGE [email protected]

110 1082 KLINIK TIGA MANDIRIJL. CABE RAYA NO 68D PONDOK CABE,

TANGERANG SELATANIBU SUSI MARKETING 021-7426414/7426366-|- 021-7426414 N Y Y ACTIVE ALL COVERAGE [email protected]

111 1552 BUNDA DALIMA HOSPITALBUMI SERPONG DAMAI, SEKTOR XIV,

BLOK J.11, NO.1BPK.ARI/ISTI MARKETING 021-53154447/8/9| 021-5385062 Y Y Y ACTIVE ALL COVERAGE [email protected]

112 1564 RSB. PERMATA SARANA HUSADAPAMULANG PERMAI, BLOK D3, NO.1-2,

PAMULANGIBU YANI MARKETING 021-7407421/22|

021-

7496346/7407421Y Y Y ACTIVE ALL COVERAGE

[email protected]/psarhu

[email protected]

113 1527 RSIA. TIARAJL. RAYA SERANG, NO.1, KM.4.5,

CIKUPAJIHAD M MARKETING 021-5961999| 021-5960699 Y Y Y ACTIVE ALL COVERAGE [email protected]

114 1528 RB & KLINIK ILANUR JL. RAYA SERANG, NO.1, BALARAJABPK MUSAFA / IBU

MELA

MARKETING/PENA

GIHAN021-5953241| 021-5954473 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

115 1547 KLINIK AMIRAGRIYA LOKA SEK 1.6 BLOK A1 NO.3

BSD, TANGERANG SELATAN

DR.WENNY / BPK

INDRAKOORDINATOR 021-5384219| 021-53164795 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

116 1324 RSIA. CINTA KASIHJL. CIPUTAT BARU RAYA NO.10

CIPUTATBPK GUNAWAN kasir 021 - 74706020 / 7424639| 021 - 74707986 Y Y Y ACTIVE ALL COVERAGE [email protected]

117 1366 KLINIK KARTIKAJL. WR SUPRATMAN NO.25 RENGAS

CIPUTAT TIMUR, TANGERANG SELATANDR DIAN/BP MARDI MARKETING 021-7371987,73881646| 021-73692937 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

118 1455 KLINIK PRADHANARUKO PANORAMA NIAGA NO.14-15

JURUMUDI BARU BENDABPK. BURHANUDIN KOORDINATOR 021-55767587| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

119 1459 KLINIK KARUNIA SEHAT IIJL. PAHLAWAN SERIBU RAYA RUKO TOL

BOULEVARD BLOK B NO.18.BSD CITYDR.MERRY KOORDINATOR 021-53158045| 021-53158046 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

120 1467 RSIA. MUTIARA BUNDA TANGERANGJL. DR. CIPTO MANGUNKUSUMO, NO.3,

CILEDUGBPK. SAIFUL MARKETING 021-7301365/73454951| 021-73454952 Y Y Y ACTIVE ALL COVERAGE [email protected]

121 1471 KLINIK MELIA MEDIKAKOMP. RUKO DUTA GARDEN SQUARE

BLOK C NO 2, TANGERANGDR AULIA - 021-51488219/54370568| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

122 1575 MOM & CHILD CLINICJL. RAYA KELAPA DUA RUKO PDA KAV.

25-29 GADING SERPONG TANGERANGDINI MARKETING

021-54214848 /

083804104440|021-54209393 N Y Y ACTIVE ALL COVERAGE [email protected]

123 1491 RS. HERMINA TANGERANG JL. KS.TUBUN NO.10 PASAR BARU IBU RUTH MARKETING 021-55772525| 021-5582705 Y Y Y ACTIVE ALL COVERAGEtangerang@herminahospitalgrou

p.com

124 1594 RSU. DINDAJL. GALUH NO.2 JATIUWUNG,

TANGERANGIBU.IKO MARKETING 021-55650577| 021-55652149 Y Y Y ACTIVE ALL COVERAGE -

125 1598RS. KARANG TENGAH MEDIKA

(GROUP YADIKA)

JL. KARYAWAN IV, KARANG TENGAH

TANGERANG

BPK DIDIN / BPK

IRFANMARKETING 021-7336699/7335599| 021-7333598 Y Y Y ACTIVE ALL COVERAGE [email protected]

126 1608 RS. SARI ASIH CIPUTATJL. OTISTA RAYA NO. 3 SASAK TINGGI

CIPUTAT, TANGERANG SELATAN

IBU INDRI/ BPK

TRIONOMARKETING 021-7410808| 021-7424445 Y Y Y ACTIVE ALL COVERAGE [email protected]

127 1340 RSIA. KELUARGA KITAJL. RAYA PLP CURUG KM. 4 NO. 8, DS

SUKABAKTI CURUGIBU SISSI MARKETING

021 - 59491011 / 021 -

5986572|

021-

5984991/5982788Y Y Y ACTIVE ALL COVERAGE [email protected]

128 1292 RS. MEDIKA BSDJL. LETNAN SOETOPO KAV. KOM. III A

NO 7, BSD TANGERANGIBU VRINA MARKETING 021 - 5372296| 021 - 5382296 Y Y Y ACTIVE ALL COVERAGE

rsmedika-

[email protected]/vrina_ardina@y

ahoo.com

129 1086 RSU. SARI ASIH SANGIANGJL. RAYA MAUK.KM.3,5 SIMPANG TIGA

SANGIANGBIDAN PRETTY KOORDINATOR 021-5582732-|- 021-55791307 Y Y Y ACTIVE ALL COVERAGE

[email protected]/i

[email protected]

130 0412RS. PREMIER BINTARO (d/h

RS.INTERNASIONAL BINTARO)

JL. MH THAMRIN NO.1, SEKTOR 7,

BINTARO JAYABAPAK DANI MARKETING 021-745 5500/27625500|

021-748

64854/745 58Y Y Y ACTIVE ALL COVERAGE

marketing@rs-

internasionalbintaro.com;

pringgodani

131 0308 PAMULANG MEDICAL CENTERJL. RAYA PAMULANG BLOK D II/2,

PAMULANGBPK. MEDIARTO MARKETING 021-740 5317|

021-

7497624/7429156N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

132 0610 RSIA. PUTRA DALIMAGRIYA LOKA, SEKTOR 1.2, BLOK UA/26-

27, BUMI SERPONG DAMAIBP. ARI WIDODO MARKETING

021-5380375/5388279021-

5388279 / 53741|021-

5388279 / 53741

021-5381220 Y Y Y ACTIVE ALL COVERAGE [email protected]

133 0007 RS. UIN SYARIF HIDAYATULLAH JL. IR. H. JUANDA, NO.95, CIPUTAT IBU FAIZ/IBU LIA MARKETING 021-7402718| 021-7493532 Y Y Y ACTIVE ALL COVERAGEhumas_rssyarifhidayatullah@yah

oo.co.id

134 0062 KLINIK SARANA MEDIKA BARUJL. RAYA PERUMAHAN KOTA BUMI

KP.TERITI DS.KARET.SEPATANBPK. SOLICHIN KEUANGAN

021-5921153 /

02159372781|021-59308529 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

135 0291 RS. ICHSAN MEDICAL CENTER (IMC)JL. RAYA JOMBANG NO.56 BINTARO

SEKTOR IX, TANGERANGIBU DEWI MARKETING

021-7456379021-

7456386|021-7456386021-7450819 Y Y Y ACTIVE ALL COVERAGE [email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 5 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI136 0696 KLINIK DOKTER KELUARGA MAWAR

JL. KARET RAYA, BLOK 7/69,

PERUMNAS TANGERANG

TINA ,MARTINA DR

BOY

SINATRALUWIYA

ADMINISTRASI021-5525633; 021-

5913616|021-5913616021-5913616 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

klinik-

[email protected]

.id;

137 0344 RS. QADRKOMPLEK ISLAMIC VILLAGE, KELAPA

DUABPK. EMONG MARKETING 021-546 4466| 021-547 0775 Y Y Y ACTIVE ALL COVERAGE [email protected]

138 0064RB & KLINIK 24 JAM DIANA PERMATA

MEDIKAJL. MH. THAMRIN, NO.87C

BPK. ARIEF

RAMADHANKEUANGAN

021-5397314/ 53124105021-

5395312|021-5395312

021-

5394105/5312410Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

om

139 0337 RS. BHINEKA BAKTI HUSADAJL. CABE RAYA NO.17 PONDOK CABE

PAMULANGBPK. ERIK/LILA MARKETING 021-7490018/7490829| 021-7403535 Y Y Y ACTIVE ALL COVERAGE [email protected]

140 0902 RB & KLINIK BUNDA MULYA (H UPEN)JL. SUMANTRI NO. 11 MEKAR MULYA

PARUNG PANJANGIBU UPEN/NURUL PIMPINAN 021-5978058-|- 021-5978058 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected];

141 0912 KLINIK KARUNIA SEHATRUKO CIKUPA BLOK B NO.21-23,

DEPAN PERUM CITRA RAYA- CIKUPADR.MERRY PENGELOLA 021-5963001-|- 021- 59408388 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

142 0702 KLINIK MAHARANI

BOROBUDUR RAYA NO 152 PERUMNAS

II BENCONGAN KELAPA DUA,

TANGERANG

BPK TONI/BPK

WisnuMARKETING 021-55654096; 5919953| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

143 0285 RS. MELATI JL. MERDEKA, NO.92 IBU UNI MARKETING 021-5523945/55776739|

021-

55769914/552002

8

Y Y Y ACTIVE ALL [email protected];

[email protected]

144 0108 KLINIK PROVITA JL. IR.H.JUANDA NO.125 CIPUTAT IBU DWI KOORDINATOR 021-749 2619| 021-744 0085 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

145 0091MAYAPADA HOSPITAL (D/H RS.

HONORIS)

JL. HONORIS RAYA, KAV.6, KOTA

MODERN/KODYA DATI IIIBU ANI MARKETING 021-5529035|

021-

5529465/5529036Y Y Y ACTIVE ALL COVERAGE

[email protected]

om;any.setyo@mayapadah

146 0022 RS. SARI ASIH KARAWACI JL. IMAM BONJOL NO.38 IBU INDRI MARKETING021-552 2794; 021-

5523239|021-5523239021-5525214 Y Y Y ACTIVE ALL COVERAGE

[email protected]/mkt_rssac@y

ahoo.co.id

147 0733 RS. OMNI ALAM SUTERAJL. ALAM SUTERA BOULEVARD KAV.25

SERPONG - TANGERANGBP.AMRI / YUSAK MARKETING

021-5312 5555/85550711 -

353438|0711 - 353438021-5312 8666 Y Y Y ACTIVE ALL COVERAGE

[email protected]

;

148 0833 RS. BUNDA SEJAHTERAJL. RAYA PURI AGUNG NO 3, KOTA

BARU- PASAR KEMISIBU ZAHRA - 021-5925876/5925889| 021-5925889 Y Y Y ACTIVE ALL COVERAGE [email protected]

149 0844 RSIA. BUNDA SEJATIJL. PRABU SILIWANGI NO.11,

JATIUWUNGIBU NENI MARKETING 021-5900136| 021-5900056 Y Y Y ACTIVE ALL COVERAGE [email protected]

150 0859 RS. AMINAH TANGERANG

JL. HOS COKROAMINOTO (CILEDUG

RAYA) NO.4A KREO SELATAN-

LARANGAN

BAPAK EKO MARKETING021-7371919021-

7371818|021-7371818021-7371333 Y Y Y ACTIVE ALL COVERAGE [email protected]

151 0955DENTAL PREMIER BINTARO ( D/H

DENTAL INTERNASIONAL

JL. MH THAMRIN NO.1, SEKTOR 7,

BINTARO JAYAIBU TRIA

KOORDINATOR

POLIGIGI

021-745 5500; 021-

27625500 ext 1680|-

021-748

64854/745 58N Y Y PARTIAL DENTAL

[email protected].

id

152 0737 RS. USADA INSANIJL. KH HASYIM ASHARI NO.24

CIPONDOH, TANGERANGIBU. WIDA / VERNA MARKETING

021-55752575/5521270021-

55755665/5521272|021-

55755665/5521272

021-55754335 Y Y Y ACTIVE ALL [email protected]/hu

[email protected]

153 1619 RSIA. BUAH HATI PAMULANGJL. RAYA SILIWANGI NO 189 PONDOK

BENDA PAMULANGIBU YUNITA Marketing 021-7414488| 021-7420322 Y Y Y ACTIVE ALL COVERAGE -

154 3791 RSB. CITRA ANANDA JL. RE MARTADINATA NO. 30, CIPUTATIBU DEASY

(081219704760)Marketing (021) 7401347| (021) 7491701 N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

155 2744 RSIA. AQIDAHJL. RADEN FATAH NO.40 PARUNG

SERAB, CILEDUG, TANGERANG

AHMAD YUSLI

FARHANDIREKTUR 021 73450244, 7319025| 7310851 EXT.222 Y Y Y ACTIVE ALL COVERAGE [email protected]

156 3047 RSIA. VITALAYAPERUMAHAN PONDOK BENDA INDAH JL.

SILIWANGI NO 1 PAMULANGNUNU NURHAYATI marketing 021-7470 3313| - Y Y Y ACTIVE ALL COVERAGE [email protected]

157 3982 KLINIK & APOTEK KF PALEM SEMI

JL. RUKO BARCELONA NO.23

PERUMAHAN PALEM SEMI KARAWACI

TANGGERANG

CINDI PRASASTI - 02129662588| N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

158 3983 KLINIK & APOTEK KF CITRA

RUKO TAMAN PALMA JL. RAYA

BOULEVARD BLOK G1 NO.25R CITRA

RAYA-CIKUPA

TIKASARI 02159409460| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

159 0772 MEDIPRO CLINIC PASAR KEMISPERUM WISMA MAS, BLOK A1, NO.30-

31, PASAR KEMIS, KUTA JAYAIBU DIANA KOORDINATOR 021-59318964| 021-59318965 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

koord.pasarkemis@medicompri

ma.co.id

160 0021SILOAM HOSPITALS LIPPO VILLAGE

(KARAWACI)

JL. SILOAM NO.6, LIPPO KARAWACI

1600

ROOSMEINY

KARTIKA

PUTRI/DIH/LINA

MARKETING 021-546 0055/25668000|021-

5460921/546008Y Y Y ACTIVE ALL COVERAGE

Roosmeiny.Kartika@siloamhospit

als.com

161 3532 CLINIC ICON 8JL. HORISON BROADWAY BLOK M2 NO.

3 BSD CITY , TANGERANG

DR. JOHANES/

DR.MELANIOWNER

(021) 33438000/ 021

94588000|(021) 68538820 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

162 3978 KLINIK & APOTEK KF 447 CIRENDEU JL. CIRENDEU RAYA NO.27C CIPUTATANANDA DESSI

S.FARM.APT- 021-7415997| -021-7415997 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]/bmjay

[email protected]

163 3979 KLINIK & APOTEK KF 267 BINTAROJL. BINTARO UTAMA V BLOK EA 2

NO.35 BINTARODEWI EKASARI - 021-7371018| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

164 1774 RS. DR. SUYOTO PUSREHAB KEMHAN JL. RC VETERAN NO. 178 BINTARO WULANSARI Marketing 021-73884000|021-7342581,

7369156Y Y Y ACTIVE ALL COVERAGE [email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 6 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI165 3999 KLINIK PESONA LEGOK

JL. RAYA LEGOK KM 7 DESA CIJANTRA

KEC. LEGOK, KARAWACI, TANGERANG,

BANTEN

DR. EDDY OWNER 021-54220281| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

166 1682 RSU. ST CAROLUS SUMMARECONJL. GADING GOLF BOULEVARD KAV. 08

GADING SERPONG

IBU KURNIA

AGUSTIN/IBU

MARLIANI

MARKETING 021-54220811| 021-54220810 Y Y Y ACTIVE ALL [email protected];

nia@carolussummarecon.

167 1637 RS. MULIA INSANIJL. RAYA SERANG KM 16.8 CIKUPA

TANGERANGIBU EKA / IBU NEVA MARKETING

021-

5962790/5962998/5962996

|

021-5963099 Y Y Y ACTIVE ALL [email protected]/neva

[email protected]

168 1487 RS. MULYAJL. KH.HASYIM ASHARI NO.18

SUDIMARA PINANGIBU NINA MARKETING 021-7322443|

021-

7310721/7322445Y Y Y ACTIVE ALL COVERAGE

[email protected]/nina.mkt.

[email protected]

169 1768 KLINIK SATELIT GSM TANGERANG

JL. KH. HASYIM ASHARI BABAKAN

TANGERANG, RUKO MODERNLAND

BLOK AR NO 19-20

IBU RATNA - 021-55748000| 021-4254816 N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

-

170 1659 RS. HERMINA CIPUTATJL. CIPUTAT RAYA, NO.2 KERTAMUKTI

CIPUTAT

IBU HERA/ IBU

DETAMARKETING 021-74702525| 021-74700999 Y Y Y ACTIVE ALL COVERAGE

[email protected]

om

171 1669 RSIA. BUAH HATI CIPUTATJL. ARIA PUTRA NO 399 SERUA INDAH

CIPUTAT - TANGERANGBP WIDI MARKETING 021-74632222| 021-74638568 Y Y Y ACTIVE ALL COVERAGE [email protected]

172 1670 CIPUTRA HOSPITALJL. CITRA RAYA BOULEVARD BLOK V

00/08 SEKTOR 3,4 KEC PANONGAN

IBU RISA

HARTIYASARI / DR

MONICA

MARKETING 021-59405555| 021-59405678 Y Y Y ACTIVE ALL COVERAGErisa.hartiyasari@ciputrahospital.

com

173 1812SMILE N SHINE DENTAL CARE

CENTER

ALAM SUTERA TOWN CENTER (ASTC)

BLOK 10D NO 6 TANGERANGDR. SUSANTY Owner 021-96679191| 021-29008540 N Y Y PARTIAL DENTAL [email protected]

174 1866 KLINIK SATELIT GSM BINTARORUKO ELANG RAYA KAV. 1 NO 10-11 JL.

BINTARO JAYA SEKTOR IX- - 021-7450818| 021-7450642 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

175 1867 KLINIK SATELIT GSO CENGKARENGBANDARA INTERNASIONAL SOEKARNO

HATTA CENGKARENG, TANGERANGDRG IVIE - 021-5501801| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

176 1947 KLINIK & APOTEK KF 219JL. IR H JUANDA NO 111

SITUGINTUNG, CIPUTAT- - 021-7401868| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

d

177 1810RS. KHUSUS BEDAH THT

PROKLAMASI BSD

COMMERCIAL PARK CENTRAL

BUSINESS OF DISTRICT BSD KAV.7

TANGERANG SELATAN

BP FREDI - 021-29002929| 021-29002930 Y Y Y ACTIVE ALL COVERAGE [email protected]

178 1935 APOTIK FARMARIN IV BINTAROBINTARO UTAMA SEKTOR 3 BLOK AM,

BINTARO JAYA

IBU WAHTYU FITRIA

WATI- 021-7357077| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

179 1948 KLINIK & APOTEK KF 115JL. PAMULANG PERMAI RAYA NO D2/1A

TANGERANG- - 021-7498708| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

180 2081 RSIA. RP SOEROSOJL. ARIA PUTRA NO. 9 KEDAUNG

PAMULANG, TANGERANG SELATANYOSIE NOVERHA MARKETING 021-7499199/ 7401376| 021-7400956 Y Y Y ACTIVE ALL COVERAGE [email protected]

181 1985 RS. MEDIKA LESTARI

JL. HOS COKROAMINOTO PERUM

PONDOK LESTARI BLOK C.1 NO.1-2

CILEDUG

IBU SULAS Marketing 021-5854858|021-7304150/021-

7320Y Y Y ACTIVE ALL COVERAGE [email protected]

182 1555 RSIA. DHIAJL. CENDRAWASIH NO.90, SAWAH

LAMA CIPUTAT, TANGERANG SELATANBPK SYARIEF MARKETING 021-7494550/ 70310242| 021-7494551 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

183 2128 KLINIK VIVA MEDIKA TANGERANGRUKAN TEUNGKU UMAR BLOK A1/A2

KARAWACI TANGERANG- - 021-55772097/99| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

184 2130KLINIK VIVA MEDIKA DIABETES

CARE

JL. JALUR SUTRA TIMURKAV. A20 NO

19-20 KUNCIRAN PINANG TANGERANGDR.RONI/ PUJI koordinator 021-71343034| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];ph

[email protected]

185 1949 KLINIK & APOTEK KF 78 JL. A YANI NO 135 TANGERANG ARIA Y ARMOKO - 021-5518433| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR8124484451

186 1968 BETHSAIDA HOSPITAL

DISTRICT TIVOLLI NO. 1 PARAMOUNT

SERPONG, JL. BOULEVARD GADING

SERPONG, TANGERANG

DRG. FENDERIA L.S.

MHA- 021-29309999| 021-29305999 Y Y Y ACTIVE ALL COVERAGE

general.practise@bethsaidahospi

tals.com

187 2360 RS. PERMATA IBU TANGERANGJL. KH. MAS MANSYUR NO.2 KUNCIRAN

TANGERANG

IBU OVA

(081316052411)Marketing 021-7334343/ 7300883| - Y Y Y ACTIVE ALL COVERAGE [email protected]

BENGKULU

188 2108 APOTEK KIMIA FARMA 72 BENGKULU JL. SUPRAPTO NO. 48 BENGKULU BPK TONI - 0736-20601| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

189 0848 RS. TIARA SELLAJL. S PARMAN NO. 61 PADANG JATI,

BENGKULUIBU ENSI Marketing

0736-20350021-

8221574|021-82215740736-20626 Y Y Y ACTIVE ALL COVERAGE [email protected]

190 1551 RS. BHAYANGKARA BENGKULU JL. VETERAN, NO.2 BPK. SANDY MARKETING 0736-341086/21553| 0736-349050 Y Y Y ACTIVE ALL COVERAGErsbhayangkarabengkulu@yahoo.

com

191 1021 RS. RAFFLESIA BENGKULU JL. MAHONI, NO.10, PADANG JATIBPK.AMIRUDIN /

BPK.ALITATAUSAHA 0736-21710-|-

0736-

342677/21954Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

BENGKULU

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 7 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI192 2109

APOTEK KIMIA FARMA 220

BENGKULUJL. S. PARMAN BENGKULU IBU INTAN - -| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

BANTUL

193 1437 RS. PKU MUHAMMADIYAH BANTUL JL. JEND. SUDIRMAN 124-126 IBU MARISKA WADIR KEUANGAN 0274-368587| 0274-368586 Y Y Y ACTIVE ALL COVERAGE [email protected]

SLEMAN

194 1229JOGJA INTERNATIONAL HOSPITAL

(JIH)

JL. RING ROAD UTARA NO.160

CONDONG CATUR SLEMANBPK AGUNG MARKETING 0274-4463535/4463190| - LIHAT REMAKS Y Y Y ACTIVE ALL COVERAGE

[email protected]; desy@rs-

jih.co.id

195 2974 RSI. YOGYAKARTA PDHIJL. SOLO KM. 12,5 KALASAN, SLEMAN,

YOGYAKARTA

ZULFA ADZKIA/

WAHYUMARKETING (0274) 498000| (0274) 498464 Y Y Y ACTIVE ALL COVERAGE [email protected]

196 1674 RS. PKU MUHAMMADIYAH UNIT IIJL. WATES KM 5,5 GAMPING SLEMAN

YOGYAKARTA

BPK GATOT HERU

SUGIARTOADM 0274-6499704/6499706| 0274-6499727 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

YOGYAKARTA

197 2864 RS. AN NUR JL. N.COLOMBO, NO. 14, YOGYAKARTA BPK ARI Humas 0274-585848/0274-514784| 0271-564110 Y Y Y ACTIVE ALL COVERAGE [email protected]

198 2768 KIMIA FARMA 21 JL. MALIOBORO - YOGYA NOVIARDI KOORDINATOR 0274 514980| N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

199 2170 APOTEK FARMARIN YOGYAKARTAJL. P. MANGKUBUMI NO.73

YOGYAKARTA

WUNAWAR, S.

FARM, APTAPOTEKER 0274-7822198| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

d

200 0077 RS. BETHESDA YOGYAKARTA JL. JEND.SUDIRMAN NO.70

IBU NUR

SUKAWATI/IBU RINI

HAPSARI

HUMAS0274-586688/5622460274 -

586688|0274 -586688

0274-

563312,521251Y Y Y ACTIVE ALL COVERAGE [email protected]

201 2615 KLINIK & APOTEK KF 225 JL. GODEAN KM 5 NO. 23 MODINANTENTI

HERAWATI.,S.F.,APT0274 621791| N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

202 2616 KIMIA FARMA 401 JL. SETURAN,C 3/B, JOGJADIAN SHINTARI

RAHAYU, S.SI, APT- 0274 4332880| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

203 2617 KLINIK & APOTEK KF 275 JL. KALIURANG, JOGJADRA ERNA RAHAYU

NINGHSIH APTpenanggung jawab 0274 885220| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

204 2618 KLINIK & APOTEK KF 70 JL. ADISUCIPTO 63A, JOGJAKARTA

DRA. ERNA

RAHAYUNNINGSIH,

MBA, APT

- 0274 489135| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

205 2619 KLINIK & APOTEK KF 316 JL. PALAGAN, JOGJAPRIHASTUTI,S.FARM

.,APT- 0274 869944| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

206 1400 RSU. BETHESDA LEMPUYANGWANGI JL. HAYAM WURUK NO.6 IBU ROSITA MARKETING 0274-512257/588002| 0274-547253 Y Y Y ACTIVE ALL [email protected]

m

207 1286 RS. HAPPYLAND MEDICAL CENTERJL. IPDA TUT HARS. ONO NO. 53,

TIMOHO

BPK.

HARMINTO/AJENGMARKETING 0274-550060/58| 0274-550061 Y Y Y ACTIVE ALL COVERAGE [email protected]

208 0604 RS. LUDIRA HUSADA TAMA JL. WIRATAMA NO.4 TEGALREJO 55244 IBU LUCIA EMIYATI MARKETING0274 6203330274-

620091|0274-6200910274-589087 Y Y Y ACTIVE ALL COVERAGE [email protected]

209 3297 LAB. CITO YOGYAKARTAJL. ATMOSUKARTO NO. 4 KOTABARU

YOGYAKARTARukisti wuri - 0274 563656| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

210 0747 RS. PANTI RAPIH JL. CIK DITIRO, NO.30 IBU ELIZA KONDA PPU0274-

514014/514845/563333|0274-564583 Y Y Y ACTIVE ALL COVERAGE [email protected]

211 0606RS. PKU MUHAMMADIYAH

YOGYAKARTAJL. K.H. ACHMAD DAHLAN, NO.20 BPK. EKA/ IBU LELI MARKETING 0274-512653-|- 0274-566129 Y Y Y ACTIVE ALL COVERAGE

[email protected] /

[email protected]

JAKARTA BARAT

212 0782 KLINIK MHT ANGKEJL. TUBAGUS ANGKE NO.27. TAMAN

DUTA MAS BLOK D-9B NO.2-3DR TIWI/IBU ATI

KOORDINATOR

MARKETIN021- 5675259/5679165| 021-5679165 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

213 2640 KLINIK & APOTEK KF 254JL. RAYA POS PENGUMBEN NO.11

JAKARTA BARAT

DRS. I. NYOMAN

SUKRA DARS. ANA,

APT.

- 021 5349063| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

214 1479 RS. PONDOK INDAH PURI INDAHJL. PURI INDAH RAYA BLOK S2,

KEMBANGAN SELATANIBU YUNITA SARI MARKETING 021-25695222/25695200| 021-25695265 Y Y Y ACTIVE ALL COVERAGE [email protected]

215 0018 RS. PELNIJL. AIP II K.S. TUBUN, NO.92-94,

PETAMBURAN

DR. SRI RACHMANI

M.KES, MHKESMARKETING

021-5306901-

9/5349475/5460608/54848

09021-5484809|021-

5484809

0215483145/5306

904/7Y Y Y ACTIVE ALL COVERAGE [email protected]

216 0736 RSUD. CENGKARENGJL. N. KAMAL RAYA, BUMI CENGKARENG

INDAH, CENGKARENG TIMURBPK SIGIT EXT 730 MARKETING

021-54372874/5/6 /

54372882|021-54374579 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

217 0390 RS. HERMINA DAAN MOGOTJL. KINTAMANI RAYA, NO.2, KAW.

DAAN MOGOT BARU

IBU ANIS/BPK

HENDRAMARKETING 021-5408989| 021-5449869 Y Y Y ACTIVE ALL COVERAGE

daanmogot@herminahospitalgro

up.com

218 0952 RS. PATRIA IKKTJL. CENDRAWASIH NO.1 KOMP

DEPHAN/MABES TNIDR. BUN / IBU SARI MARKETING 021-5308981-84-|- 021-5346387 Y Y Y ACTIVE ALL COVERAGE [email protected]

DAERAH ISTIMEWA YOGJAKARTA

DKI JAKARTA

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 8 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI219 1701

KLINIK DR. SANDER B (N/B KLINIK

DAYA MEDIKA)

JL. TOMANG TOL RAYA A1 NO 17-18

KEDOYA SELATAN, KEBON JERUKMULJANTO/ERWIN MARKETING 021 - 5812781/82| 021-5806065 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected] /

[email protected]

220 1945 KLINIK & APOTEK KF 96JL. LET JEND S PARMAN KAV G/12,

SLIPI, JAKARTA BARATKhaerul - 021-5481140, 5321551| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

221 0846 RS. JANTUNG HARAPAN KITA JL. LETJEN S PARMAN KAV.87 SLIPIIBU NETTY N. E.

SIREGAR

PELAYANAN

PELANGGAN021-5684093 / 5684085| 021-5601816 Y Y Y ACTIVE ALL COVERAGE [email protected]

222 0695 KLINIK KUSUMA I JL. PETA SELATAN, NO.50 DR MEIDI penanggung jawab 021-541 9747| 021-54360626 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

223 1158 RS. SUMBER WARAS JL. KYAI TAPA - GROGOL BPK. BAMBANG MARKETING 021-5682011/5605800| 021-5605791 Y Y Y ACTIVE ALL [email protected]/

sekretariat@rssumberwa

224 1102 RS. BHAKTI MULIA JL. AIPDA K.S.TUBUN, NO.79 DR DEVI Marketing 021-5481625-|- 021-5331544 Y Y Y ACTIVE ALL COVERAGE [email protected]

225 1127 JESSLYN MEDICAL CENTERPERUM.TAMAN SURYA III BLOK F/63

CENGKARENGDR. AGUS KOORDINATOR 021-54365638| 021-54365638 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

226 0643 RSB. GRHA KEDOYA JL. PANJANG NO 26, KEDOYA UTARA IBU TITIK RENGGO - 021-56982222/29910999|02129910987/569

82233Y Y Y ACTIVE ALL COVERAGE

[email protected]/info@g

rhakedoya.com

227 0381 RS. MHT CENGKARENG JL. DAAN MOGOT, KM.17 DR.TIWI MARKETING 021-54396298/6194581| 021-6194581 Y Y Y ACTIVE ALL COVERAGE [email protected]

228 0204 RS. MEDIKA PERMATA HIJAU JL. RAYA KEBAYORAN LAMA, NO.64 IBU SRI SUWARNIKEUANGAN/MARKE

TING

021 - 530 5288, 534

7411021 - 534 741|021 -

534 741

021-

53652856/530529

1

Y Y Y ACTIVE ALL [email protected];

[email protected]

229 0109 RSAB. HARAPAN KITA JL. JEND S.PARMAN, KAV.87, SLIPIFAKHRUDDIN/SRIEN

DAHPemasaran

021-

5668284/5686404/5683053

021-566 8284|021-566

8284

021-

5601816,5668285Y Y Y ACTIVE ALL COVERAGE

sriendahsetyaningrum_rsabhk@

yahoo.com

230 0836 RS. ROYAL TARUMA JL. DAAN MOGOT NO.34 GROGOL IBU ORI/ LELI PEMASARAN 021-56958338/56967788-|- 021-56958589 Y Y Y ACTIVE ALL COVERAGEkasirrawatinap@rs-

royaltaruma.com

231 0783 KLINIK MHT KALIDERESJL. PETA SELATAN RAYA-KALIDERES

INDAH I BLOK A NO.12DRG RATNA KOORDINATOR 021- 5456027| 021- 5456027 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

232 0101 SILOAM HOSPITALS KEBON JERUKJL. RAYA PERJUANGAN, KAV.8, KEBON

JERUK

IBU LIANA WIDJAJA/

BPK. PUTRAMARKETING

021- 25677888021-

5300889|021-5300889021-5321766 Y Y Y ACTIVE ALL COVERAGE

liana.natawidjaja@siloamhospital

s.com

233 3211 GETHEALTHY CLINIC

RUKAN SIXTH AVENUE J01 A NO. 20-

22, CITRA 6, KALIDERES, JAKARTA

BARAT

DR. ANGGRAINI

PUSPITAMarketing 021-29030041/42| 021-29030045 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

234 2127KLINIK VIVA MEDIKA TANJUNG

DUREN

JL. TANJUNG DUREN RAYA BLOK A

NO.38 JAKARTA BARATANI - 021-5640602/ 5641479| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

235 2294 RS. JAKARTA EYE CENTER KEDOYAJL. TERUSAN ARJUNA UTARA NO. 1

KEDOYA, JAKARTA BARAT 11520ANDHY SUYATNO - 021-29221000| - Y Y Y ACTIVE ALL COVERAGE -

236 0771 KLINIK YADIKA TEGAL ALURJL. KAMAL RAYA BLOK A7 NO.7-11

TEGAL ALUR

DR SAPTAJI / IBU

ETI

PENANGGUNG

JAWAB/ HR021-70605247 / 55351876| 021-55963484 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

d

JAKARTA PUSAT

237 0790 RSIA. BUNDA JAKARTAJL. TEUKU CIK DITIRO NO.28,

MENTENGBPK.SAMUEL MARKETING

(021) 3143215(021)

31922005|(021) 31922005

021-

3101313,3928588Y Y Y ACTIVE ALL COVERAGE [email protected]

238 0398 RS. MH. THAMRIN INTERNASIONAL JL. SALEMBA TENGAH, NO.26-28Bpk.DJATMIKO /

IBU.RITAMARKETING 021-3904422|

021-

3926934,3926931Y Y Y ACTIVE ALL COVERAGE

marketingthamrinsalemba@gmai

l.com

239 0705 KLINIK SWA INDOMEDIKAJL. JEND SUDIRMAN KAV 1, GD BNI

LANTAI BASEMENT 1IBU TANTI MARKETING 021-5728987| 021-5728990 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

240 0397 KLINIK BARUNA JL. CIKINI RAYA, NO.60 R/S DR.ASTRID MARKETING 021-3141040-059| 021-3151065 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

241 0011 RS. MITRA KEMAYORAN JL. LANDAS PACU TIMUR, KEMAYORAN IBU ESTIMARKETING

MANAGER021-6545555/888| 021-6545959 Y Y Y ACTIVE ALL COVERAGE

marketing2.kmy@mitrakeluarga.

com

242 1477 BUNDA INTERNASIONAL CLINICJL. TEUKU CIK DITIRO NO.12,

MENTENG

BPK HILMA/IBU

FIKA

KEUANGAN/MARKE

TING021-3926393| 021-3926494 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

243 0013 RS. PGI. CIKINI JL. RADEN SALEH, NO.40IBU RATNA/IBU

IRENEMARKETING 021-38997777|

021-324663/

3910277Y Y Y ACTIVE ALL COVERAGE [email protected]

244 1590 RS. BEDAH THT PROF. NIZAR JL. KESEHATAN NO.9 IBU HERA/IBU VITA MARKETING 021- 3503435/34834982| 021-34834982 Y Y Y ACTIVE ALL COVERAGE [email protected]

245 1577 KLINIK MIRACLE ( GD INDOFOOD )INDOFOOD TOWER - PLAZA SUDIRMAN

LT 8, JL. JEND SUDIRMAN KAV 76-78DR RITA/BPK ERIK MARKETING 021-57954537/38| 021-57954541 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

246 0953RS. ISLAM JAKARTA (CEMPAKA

PUTIH)JL. CEMPAKA PUTIH TENGAH I/1

BPK BAMBANG/IBU

WIWIK/BPK SOBARI

MARKETING/AdmR

.Inap

021-4250451/42801567021-

42801567|021-42801567021-4206681 Y Y Y ACTIVE ALL COVERAGE

[email protected]/rsijpu

[email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 9 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI247 1105 RS. JAKARTA EYE CENTER MENTENG

JL. CIK DITIRO 46,MENTENG JAKARTA

10310DIAH / MAS ANDI

MARKETING

CONSULT

021-29221000021-

31935600|021-31935600021-3904601 Y Y Y ACTIVE ALL COVERAGE jec@jakarta_eye_center.com

248 1709KLINIK YAKES MANDIRI-WISMA

MANDIRI

WISMA MANDIRI LT I, JL. MH THAMRIN

NO 5BP SLAMET WIYOTO - 021-39832805| 021-39832806 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

249 1700 FHL DENTAL CLINICGEDUNG BRI II LT.15 SUITE 1509 JL.

JEND SUDIRMAN NO 44-46

DRG KRISTIN

RATNAWATI- 021-57851127/ 57930552| - N Y Y PARTIAL DENTAL [email protected]

250 1702 RS. KHUSUS BEDAH SS MEDIKA JL. SALEMBA I NO 11 JAKARTA PUSATBPK IRVAN HELMI/

IBU DWI HESTIMARKETING 021-3913336/3926689| 021-3926687 Y Y Y ACTIVE ALL COVERAGE [email protected]

251 1820 RSU. BUNDA JAKARTAJL. TEUKU CIK DITIRO NO.21,

MENTENG- - 021-31922005| - Y Y Y ACTIVE ALL COVERAGE [email protected]

252 1914 RSUD. TARAKANJL. KIYAI CARINGIN NO 7, JAKARTA

PUSAT

BPK SUGIYANTO /

IBU LINA MARLINAMarketing 021- 3503003, 3842934,|

021-3810149,

3503412Y Y Y ACTIVE ALL COVERAGE [email protected]

253 1019RSPAD GATOT SUBROTO

(P.DARMAWAN)JL. ABDUL RACHMAN SALEH NO.24

IBU NOVA, NITA,

FEBRIANAAdmin

021-3500004021-

376134|021-376134

021-

3441903/3859460Y Y Y ACTIVE ALL COVERAGE [email protected]

254 0599 RS. KRAMAT 128 JL. KRAMAT RAYA, NO.128BPK HERI/IBU

WIWIKMARKETING

021-

3909814/3918287/3909514

|

021-3909125 Y Y Y ACTIVE ALL [email protected];

[email protected]

255 1115 RSPAD GATOT SUBROTO (PAV.IKA) JL. ABDUL RACHMAN SALEH NO.24BPK AHMAD & IBU

SANTIMARKETING 021-3504614| 021-3520643 Y N Y ACTIVE ALL COVERAGE [email protected]

256 1406 APOTIK FARMARIN I KEBON SIRIH

GEDUNG BANK INDONESIA JL. KEBON

SIRIH NO 82 DAN 84 GEDUNG KEBON

SIRIH LT 1

SHANTI INDAH

PALUPIKOORDINATOR 021-29810000 / 29815268| 021-2311940 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

apotikfarmarin_kebonsirih@yaho

o.com

257 1197 RSPAD GATOT SUBROTO (NON. PAV) JL. ABDUL RACHMAN SALEH NO.24IBU JUJU / HERMIN/

BPK AHMADMarketing 021-3448929| 021-3448929 Y N Y ACTIVE ALL COVERAGE [email protected]

258 1069RSPAD GATOT SUBROTO(P.IMAM

SUJUDI)JL. ABDUL RAHMAN SALEH NO.24 BPK AHMAD MARKETING 021-3441008-|- 021-3859460 Y N Y ACTIVE ALL COVERAGE [email protected]

259 1078 RSIA. BUDI KEMULIAAN JL. BUDI KEMULIAAN NO.25 IBU KIKI MARKETING 021-3842828-|- 021-3501012 Y Y Y ACTIVE ALL COVERAGE [email protected]

260 1358 RSIA. YPK - MANDIRI JL. GEREJA THERESIA, NO. 22 IBU NINDI MARKETING 021-3909725| 021-3909806 Y Y Y ACTIVE ALL COVERAGE [email protected]

261 0084 RS. JAKARTA JL. JEND. SUDIRMAN, KAV.49 BPK FAUZI MARKETING021-5732241/5741828021-

5741828|021-5741828021-5719870 Y Y Y ACTIVE ALL COVERAGE [email protected]

262 0180 RSU. MENTENG MITRA AFIA JL. KALI PASIR, NO.9 DR. NADIA MARKETING 021-3154050/3909484| 021-3146309 Y Y Y ACTIVE ALL [email protected];

[email protected];

263 0042 RS. PERTAMINA JAYA JL. A. YANI NO.2 IBU. YAYAT/MONA KOORDINATOR021-4204056/4211911021-

4211911|021-4211911021-4211913 Y Y Y ACTIVE ALL COVERAGE [email protected]

264 0135 RS. ABDI WALUYO JL. H.O.S. COKROAMINOTO, NO.31-33 DR. MIGOT/IBU ENYMARKETING /

KEUANGAN021-3144989| 021-31930866 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

265 0793 KLINIK YES CARE JL. WAHID HASYIM NO. 31C DRG ELDA Direktur 021-3915487| 021-3146659 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

266 0789 KLINIK MHT SERDANG JL. H. UNG E - 71/2 KEMAYORAN

DRG ATI

SARASWATI/BPK

APRI

KOORDINATOR/AD

M RJ021-4249519| 021- 4249519 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

267 0029 RSU. EVASARI JL. RAWAMANGUN NO.47 - PRAMUKA DR. DINA HANUMMarketing /

Keuangan021-4202851/52| 021-4209725 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

268 0787RS. KHUSUS THT-BEDAH

PROKLAMASIJL. PROKLAMASI NO.43 BPK MANSYUR MARKETING

021-

3900002/3906893/3144795

/3909783|

021-

3900947/3152548Y Y Y ACTIVE ALL COVERAGE [email protected]

269 0802SAHID SAHIRMAN MEMORIAL

HOSPITALJL. JEND.SUDIRMAN, NO.86 IBU TATI MARKETING

021- 57853911021-

5727210|021- 5727210021- 57853922 Y Y Y ACTIVE ALL COVERAGE

[email protected]/tatilamb

[email protected]

270 1495 APOTEK & KLINIK KF INDOSATGD. INDOSAT LT.23 JL. MEDAN

MERDEKA BARAT NO. 1 JAKARTA PUSAT

DRS. MARULY

MARPAUNG, APTKOORDINATOR 021-30003750| 021-30003750 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

271 0788RSPAD GATOT SUBROTO

(PAV.KARTIKA)JL. ABDUL RACHMAN SALEH NO.24 BPK AHMAD MARKETING

021-384 0484, 3441008021-

376134|021-376134

021-

3859460,3501308Y Y Y ACTIVE ALL COVERAGE [email protected]

272 1026 RSIA. TAMBAK JL. TAMBAK,NO.18 MANGGARAI IBU. AYA/ FITRI MARKETING021-

2303444/087880676072|-021-3902550 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

273 2637 KLINIK & APOTEK KF 2 JL. RAYA SENEN NO. 66DRA. ASTRID

DWIASTUTI, APT.- 021 384-4788; 384-0742| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

274 2507MITRASANA IHC KALBE CEMPAKA

PUTIH

JL. LETJEN SUPRAPTO KAV 4 CEMPAKA

PUTIH, JAKARTA PUSATINDAH - 021-42873888 EXT : 1451| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

275 3737 CHILDLABJL. KRAMAT RAYA NO. 53, JAKARTA

10450, INDONESIAIMELDA NOVIANTI - (021) 31907979| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHARImelda Novianti

276 4058 KLINIK YPK MANDIRIGEDUNG GRAHA MANDIRI LT.1 LOBBY

SELATAN,JL. IMAM BONJOL NO.61IBU WENNY KOORDINATOR 021 - 39838556| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 10 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI277 2733 KINAN MEDICAL CENTER

KOMPLEK RUKO RAWASARI MAS

NO.B10 JL. PERCETAKAN NEGARA,

CEMPAKA PUTIH JAKARTA PUSAT

KISWORO - -| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

m

278 2735 THOMSON SPECIALIST CENTERJL. IMAM BONJOL NO.72, MENTENG

JAKARTA PUSAT 10310

IBU GRATA

A.PUSPANINGRUM- 021-3910030| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

279 1633KLINIK GARUDA SENTRA MEDIKA (

GSM )

JL. ANGKASA BLOK B.15 KAVLING 1,

KEMAYORAN

BPK YOGO/ IBU

RETNOMARKETING 021-4241000| 021-4254816 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

280 2745 KYOAI MEDICAL SERVICESWISMA KEIAI LT. 6 JL. JEND

SUDIRMAN KAV 3-4 JAKARTABPK ERY marketing 021-5734550| 021-5736790 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

281 2405 HENDRA HIDAYAT IMPLANT CENTER

SAHID SUDIRMAN RESIDENCE LT. 1

UNIT 1, JL. JEND. SUDIRMAN NO. 86

JAKARTA PUSAT

IBU RINI MARKETING 021-52970102/104| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

282 1054 RS. HUSADAJL. RAYA MANGGA BESAR 137-139,

JAKARTA PUSAT BAG UTARA

IBU MEYLISA / IBU

RINA/CATURMARKETING

021-6260108021-

6490090|021-6490090021-6497494 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

283 0600 RS. ST. CAROLUS JL. SALEMBA RAYA, NO.41DR. WELLEM H.

T/DR. UTIE/FARIDA

Marketing/CO

Klinik021-3904441|

021-

3922831/3154183Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

284 2406HENDRA HIDAYAT DENTAL CENTER

(HHDC)

THAMRIN CITY - OFFICE SUITE FLOOR

3 UNIT 2, JL. KH. MAS MASYUR

JAKARTA

DEBRA -

08164830122- 021-3199 7482| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

285 2636 KLINIK & APOTEK KF 1 JL. GARUDA NO.47, JAKPUS MARULI MARPAUNG - 021 424-5572| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]/kimi

[email protected]

JAKARTA SELATAN

286 3974 LAB. KLINIK CITO JAKARTA

JL. RS. FATMAWATI NO. 27 A, RT.001

RW.006 KEL. GANDARIA SELATAN,

CILANDAK, JAKSEL

IBU NINA (021) 766 4036| (021) 766 3640 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

om

287 4234RAYS INTERNATIONAL DENTAL

CLINIC

JL. BRAWIJAYA VIII NO. 2, JAKARTA

SELATANIBU ENDANG KOORDINATOR 021-7262347| 021-7225844 N Y Y ACTIVE ALL COVERAGE [email protected]

288 3989KLINIK & APOTEK KF NO. 55

KEBAYORAN

JL. KEBAYORAN LAMA NO. 34K

JAKARTA SELATANWAHYU DWI - 021-7226444/7203563| 021-7203563 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

289 0597 KLINIK JMC DHARMA BHAKTI JL. CILANDAK KKO RAYA NO.45 IBU SRI WAHYUTI MARKERTING021-781 9848 /

0217989123|- N Y Y ACTIVE ALL COVERAGE [email protected]

290 2932 APOTEK KF55 CINERE

PLN P3B JB KRUKUT-LIMO, CINERE

16514, KOTAK POS 159 CINERE

JAKARTA SELATAN

WAHYU DWI

PURNOMO- 021 7220292| N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

291 3540FHL DENTAL CLINIC EPPIWALK

OFFICE

EPPIWALK OFFICE SUITES LT. 6 UNIT B

629, JL. H.R. RASUNA SAID KEL. KARET

KUNINGAN KEC. SETIABUDI

DR. CHRISTIN - 021-29912232| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

292 0854 RS. ZAHIRAH JL. SIRSAK NO.21, JAGAKARSA IBU ARINI INDAH MARKETING

021-

78888723/7872210/788887

21021-78888723|021-

78888723

021-

7270013/7872210Y Y Y ACTIVE ALL COVERAGE [email protected]

293 0797 RS. MEDISTRA JL. GATOT SUBROTO KAV.49 IBU YORA/ ELLI MARKETING 021-5210200| 021-5210184/5 Y Y Y ACTIVE ALL [email protected];

[email protected]

294 2954 KLINIK AJI WARAS KARANG TENGAH

JL. KARANG TENGAH RAYA NO.60,

LEBAK BULUS, CILANDAK, JAKARTA

SELATAN 12440

DRG. ESTHER - (021) 75909473| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

295 1712KLINIK SUNFLOWER DENTAL &

HEALTH CARE

JL. KARANG TENGAH RAYA NO.8V

BONA INDAH BISNIS SENTER, LEBAK

BULUS

BP SUJIO - 0212923-7071, 7110-6511| 021-29203541 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

296 2807KLINIK PERTAMEDIKA PONDOK

RANJI

JL. WR SUPRATMAN NO. 43 (KAMP

UTAN) TANGERANG SELATANANNA - 021-7355253| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

297 1488 RS. ASRI JL. DUREN TIGA RAYA, NO.20 BPK BUDI / IBU ANI MARKETING 021-7995566,7992211|02179198118/791

98733Y Y Y ACTIVE ALL COVERAGE [email protected]

298 2797 KLINIK PERTAMEDIKA PHEPHE TOWER LT. 2 JL. TB SIMATUPANG

KAV. 99TRES - 021-29547300| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

299 1066MRCCC-SILOAM HOSPITALS

SEMANGGI (D/H SPECIALIST C

JL. GARNISUN 2-3 KARET, SEMANGGI

SETIABUDI (BELAKANG UNIV.

ATMAJAYA ) JAK- SEL

YUNITA

SULISTYOWATI/IBU

DEBORAH/AGUSTIN

E

Business &

Marketing021-29962888| 021-29962778 Y Y Y ACTIVE ALL COVERAGE

marketing.mrccc@siloamhospital

s.com;mrccc.corpor

300 1752 LAB. KLINIK BIOTEST WIJAYAJL. WIJAYA I NO 58, KEBAYORAN

BARU, JAK-SELIBU NINA/YANTI Marketing 021-7232445| 021-7268711 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];biol

[email protected]

301 1936 APOTIK FARMARIN VI RASAMALAWISMA PPBI JL. RASAMALA NO.2

PANCORANYANUILA DARYATI - 021-8290073| 021-83794460 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 11 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI302 2086 KLINIK GLOBAL DOCTOR

JL. KEMANG RAYA NO. 87 JAKARTA

SELATANBP SUGANDI IT/GA 021-7194565| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

303 2082 BRAWIJAYA CLINIC @ FX SUDIRMAN

FX SUDIRMAN LT 5 (F5) KAV. 8A-8B, JL.

JEND SUDIRMAN PINTU SATU SENAYAN

JAKARTA

SYUKRIAH - 021-25554156| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

304 2033 KLINIK NAMIRAJL. JATIPADANG RAYA NO. 62 PASAR

MINGGUBPK AIRLANGGA - 021-7820645/78830676| 021-7820645 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

305 0228 RSIA. KEMANG MEDICAL CARE JL. AMPERA RAYA, NO.34,KEMANG

IBU LENI

SUSILAWATI/TRI

WULANDARI

MARKETING

021-

27545454/27545400/021-

6317288|021-6317288

021-78843548 Y Y Y ACTIVE ALL COVERAGEmarketing@kemangmedicalcare.

com

306 2174 SILOAM HOSPITALS SIMATUPANGJL. RA KARTINI NO.8 CILANDAK

JAKARTA SELATAN, 12430ARIE ARIMBI Marketing 021 2953 1900 EXT 22601| 021 759 16997 Y Y Y ACTIVE ALL COVERAGE

anastasia.hermawan@siloamhos

pitals.com

307 2138 KLINIK PERTAMEDIKA PATRA JASAPATRA JASA OFFICE TOWER, JL. JEND.

GATOT SUBROTO KAV.32-34LILI - 021-5228026/ 5217318| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

308 2139 KLINIK PERTAMEDIKA SINABUNG

JL. SINABUNG II NO. 32 AF KEL.

GUNUNG KEC. KEB. BARU JAKARTA

SELATAN

SUNARDI - 021-7243262/7243282| 021-72800985 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

309 0796RS. METROPOLITAN MEDICAL

CENTRE ( MMC )

JL. HR. RASUNA SAID, KAV. C21,

KUNINGAN

DR.LITA CORNELIA/

IBU RATIHMarketing 021- 5203435/0811865958|

021-

5226070/5227060Y Y Y ACTIVE ALL COVERAGE

[email protected]/marketi

[email protected]

310 2229BRAWIJAYA CLINIC & LIFE STYLE @

OKTROI KEMANG

OKTROI PLAZA, MEDICAL MEZZANINE

LT. 3 JL. KEMANG UTARA RAYA NO. 1

JAKARTA SELATAN

IBU RIKE - 021 - 7197580/ 71792101| 021 - 71792074 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

311 2418 KLINIK DENTIST AND DENTINSJL. WOLTER MONGONSIDI NO.58 C

JAKARTA SELATANBPK FACRUL - 0217210480| -- N Y Y PARTIAL DENTAL

312 2341 KLINIK AJI WARAS CILANDAK

JL. CILANDAK KKO NO.45A, RAGUNAN,

PASAR MINGGU, JAKARTA SELATAN

12550

IBU RUSTINI/DRG

ESTHERKoordinator (021) 78836308; 78835703| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

313 2356MAYAPADA HOSPITAL JAKARTA

SELATAN (MHJS)

JL. LEBAK BULUS I KAV. 29, JAKARTA

SELATANIBU SHINTHA Marketing 021-29217777| 021-29216666 Y Y Y ACTIVE ALL COVERAGE

febrina.shintha@mayapadahospi

tal.com

314 2379 DRG. ANGGRAENI

JL. PALAPA I NO. 4 KOMPLEK

PERTANIAN PASAR MINGGU JAKARTA

SELATAN 12520

DRG ANGGRAENI - 021-7806291| 021- 7806291 N Y Y PARTIAL DENTAL -

315 2641 KLINIK & APOTEK KF 42JL. ST. HASANUDDIN NO.1

KEBAYORAN BARU JAKARTA SELATAN

DRS. I WAYAN

BUDHI

ARTHAWAN,APT

- 021 7220292| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

316 0049 RS. PONDOK INDAHJL. METRO DUTA, KAV. UE, PONDOK

INDAHIBU DETTY MARKETING 021-7657525| 021-7502324 Y Y Y ACTIVE ALL COVERAGE

benjamin.baldwinromanda@rspo

ndokindah.co.id

317 1089RS. KHUSUS THT & BEDAH

CIRANJANGJL. CIRANJANG NO.20-22 KEB.BARU IBU TIKA MARKETING

021-

7243366/7208192/7208192

|021-7208192

021-7264038 Y Y Y ACTIVE ALL COVERAGE [email protected]

318 1554 H2E DENTAL CLINIC

MENARA KUNINGAN,JL. HR. RASUNA

SAID BLOCK X-7 LT1. UNIT I,

KUNINGAN

DR. EFINDY MARKETING 021-30040151/152| 021-30040152 N Y Y ACTIVE ALL COVERAGE [email protected]

319 1574 DE BLITZR DENTAL CARE II

WISMA ARGO MANUNGGAL LT. 1 JL.

GATOT SUBROTO KAV. 22 JAKARTA

SELATAN

IBU HANIManager

Pemasaran021-2520124| 021-2522014 N Y Y PARTIAL DENTAL

320 1458MULIA HEALTH AND DENTAL CARE

(MHDC)

GEDUNG MENARA MULIA, SUITE LG, JL.

JEND.GATOT SUBROTO, KAV.9-11DRG.MAEMUNAH ALI - 021-5223838| 021-52901073 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

321 0799 RS. GANDARIAJL. GANDARIA TENGAH II, NO.12-14,

KEBAYORAN BARU

IBU FEMI DAN IBU

LISMARKETING 021- 7250718/ 7203311| 021- 7222038 Y Y Y ACTIVE ALL COVERAGE [email protected]

322 0800 KLINIK TRIAZ PERSADAGRAHA NIAGA TOWER LT.B1, JL. JEND.

SUDIRMAN NO.58IBU NURHASAH KOORDINATOR 021- 2505250| N Y Y ACTIVE ALL COVERAGE [email protected]

323 0193 RSIA. BUDHI JAYA JL. DR. SAHARJO, NO.120IBU RETNO, IBU

CHRISMARKETING

021-8292672/8311722021-

8311722|021-8311722021-8301901 Y Y Y ACTIVE ALL COVERAGE [email protected]

324 0890 KLINIK INTERMED HEALTH & BEAUTYJL. KEBAGUSAN 1 NO. 8 JAKARTA

SELATAN 12520IBU LANI MARKETING 021-7823501| 021-7823502 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

325 1708KLINIK YAKES MANDIRI-PLAZA

MANDIRI

PLAZA MANDIRI LT. BASEMENT I, JL.

JEND GATOT SUBROTO KAV 36-38BP SLAMET WIYONO - 021-5245351, 5245351| 021-5245351 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

326 1872 KLINIK TRIHATI PLUSRUKAN ROYAL PALACE BLOK A5, JL.

PROF DR SOEPOMO SH NO 1IBU. RIA MARKETING 021-829 9119| 021-8299113 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]/marketin

[email protected]

327 1942 KLINIK & APOTEK KF 47JL. RADIO DALAM RAYA 1-5, JAKARTA

SELATAN- - 021-7208735| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

328 1944 KLINIK & APOTEK KF 152JL. RAYA PASAR MINGGU KM 18

JAKARTA SELATANIBU ELISABETH Marketing 0217943222| 021-7943223 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

329 0842BRAWIJAYA WOMEN & CHILDREN

HOSPITAL

JL. TAMAN BRAWIJAYA NO.1 CIPETE

UTARAIBU WIWIN MARKETING 021 - 7211337| 021 - 7211364 Y Y Y ACTIVE ALL COVERAGE [email protected];

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 12 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI330 0853 RB & KLINIK PRIMA HUSADA CINERE

JL. CINERE RAYA BLOK F1 NO.1

CINERE JAKSEL

DR. DESMAN / IBU

MAURI SARAGIKOORDINATOR 021-7546263/7547382| 021-7540062 N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

berkah_prima_husadatama@yah

oo.co.id

331 0879 RSU. YADIKA CIPUTATJL. CIPUTAT RAYA, NO.5, KEBAYORAN

LAMAIBU.ERNA MARKETING 021-7291074| 021-72895046 Y Y Y ACTIVE ALL COVERAGE [email protected]

332 0593 RS. SETIA MITRAJL. RS. FATMAWATI, NO.80-82,

CILANDAKIBU TARI/PUJI MARKETING

021-

7656000/7651021/7654676

|

021-

7656880/7656875Y Y Y ACTIVE ALL COVERAGE [email protected]

333 0999RSU. MUHAMMADIYAH TAMAN

PURING

JL. GANDARIA I NO.20 KEBAYORAN

BARU

DRG. LUKMAN / IBU

CITRAMARKETING

021-

7229623/7250243/7208358

021-7208358|021-7208358

021-

7234823/7210516Y Y Y ACTIVE ALL COVERAGE [email protected]

334 0957KLINIK PETUKANGAN MEDICAL

CENTREJL. CILEDUG RAYA NO.8A BU. RITA Sekretariat 021-7340906-|- 021-73889956 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected] atau

[email protected]

335 0972 RSIA. AULIAJL. JERUK RAYA NO 15 JAGAKARS. A,

JAKARTA SELATANIBU HAURA Marketing 021-7270208-|- 021-7866057 Y Y Y ACTIVE ALL COVERAGE

[email protected];

marketing.rsiaaulia@gmail

336 1408 BIDAKARA MEDICAL CENTER (BIMC)

GEDUNG BINA SENTRA, LT.DASAR,

KOMP.BIDAKARA, KAV.71-73,

PANCORAN

IBU . JUWITA MARKETING 021-83783535/83783636| 021-83785349 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

337 1412 APOTIK FARMARIN III BIDAKARA

GED. BINASENTRA KOMP. BIDAKARA

JL. GATOT SOEBROTO KAV. 71 - 73

JAKARTA

ARI

PRIHANTINI/IBU.

SANTI

KOORDINATOR 021 - 83704414| 021 - 83793006 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

338 1424 RSB. ASIHJL. PANGLIMA POLIM I NO.34 JAKARTA

SELATAN 12160

IBU INDY/ IBU NING

BANGUN

MARKETING DAN

HUMAS021-2700609-10| - Y N Y ACTIVE ALL COVERAGE [email protected]

339 1076 KLINIK YADIKA PETUKANGANJL. DAMAI RAYA NO.1 PETUKANGAN

SELATAN - JAKARTA SELATANDR.ROS INTAN

PENANGGUNG

JAWAB021-7370881-|- 021-73887810 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]/rs

[email protected]

340 1083 RS. MATA AINIJL. H.R.RASUNA SAID (KUNINGAN)

JAKARTA

IBU NOVI/IBU

SRI/IBU

KIKI/ZR.UTIN

ADM RI021-5256228/5203866021-

5203866|021-5203866

021-

5265618/5224288Y Y Y ACTIVE ALL COVERAGE [email protected]

341 1546 KLINIK NDH (RAJA SERVICE) JL. RADIO DALAM RAYA, NO.54A DRG.NINA DELI KOORDINATOR 021-7257244| 021-7257244 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

342 0112 SUDIRMAN MEDICAL CENTER JL. KARET BELAKANG TIMUR NO. 17 IBU EKA MARKETING 021-5203467/96277627| 021-5203468 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

343 0110 RS. TRIA DIPAJL. RAYA PASAR MINGGU, NO.3A,

PANCORAN

BPK. DEDE/ IBU

WITAMARKETING 021-7993058,7974071-73| 021-7974074 Y Y Y ACTIVE ALL COVERAGE

[email protected]

;[email protected]

344 0034 ADITYA MEDICAL CENTERJL. ADITYAWARMAN I, NO.14,

KEBAYORAN BARU

DR.OKKI/IBU

YANTI/ITA

KEUANGAN/KOOR

DINATOR021-7228639| 021-7228922 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

345 0041 RS. AGUNGJL. SULTAN AGUNG, NO.67, PASAR

RUMPUTIBU WITA/PUJI MARKETING

0218294955,8305768/9,828

2795,83794207|021-8305791 Y Y Y ACTIVE ALL COVERAGE

[email protected]/ja

[email protected]

346 0795 RS. PUSAT PERTAMINA JL. KYAI MAJA 43, KEBAYORAN BARU MARDALENA Marketing (021) 7219204/7219700| (021) 7203540, Y Y Y ACTIVE ALL [email protected];ros

[email protected]

347 0199 MEDICARE CLINIC

MENARA KADIN INDONESIA, 27TH

FLOOR, JL. H.R. RASUNA SAID, BLOK X-

5, KAV.2-3

BPK. HERRY

SETIAWANMARKETING 021-57903905| 021-5274754 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

348 0775 RSB. DUREN TIGAJL. DUREN TIGA RAYA, NO.5,

PANCORANIBU TIKA / LIA

MARKETING /

PIUTANG021- 794 1843| 021- 790 1050 Y Y Y ACTIVE ALL COVERAGE [email protected]

349 0794 RS. SIAGA RAYAJL. PEJATEN BARAT KAV.4-8, PASAR

MINGGU, JAKARTA SELATANIBU SHEILA MARKETING 021- 7972750| 0217970627/6 Y Y Y ACTIVE ALL COVERAGE [email protected]

350 0401KLINIK SPESIALIS & APOTIK, RSB.

ESTI

JL. BANGKA RAYA, NO.28-30, PELA

MAMPANGBPK TEVI GUNAWAN MARKETING 021-7194434-35| 021-71791917 Y Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]/market

[email protected]

351 0892 KLINIK FAMILY DENTISTRY JL. PANGLIMA POLIM II/2DRG S.ADI

WIRADIDJAJAKoordinator 021-7267267-|- 021-7264365 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

352 0395 RS. PRIKASIHJL. RS. FATMAWATI, NO.74, PONDOK

LAB. U - CILANDAKBPK AANG MARKETING

021-

7501192/7504669/7590117

4021 - 7504669|021 -

7504669

021-7505148 Y Y Y ACTIVE ALL COVERAGE [email protected]

353 0400 MEDIKALOKA HEALTHCARE CENTERJL. HR. RASUNA SAID, BI X-1,

KUNINGANBPK.NINO MARKETING 021-5261118| 021-5261119 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

354 0758 DE BLITZR DENTAL CARE

BELLEZZA SHOPPING ARCADE UNIT

230-231ARTERI PERMATA HIJAU,JL.

LETJEND SOEPENO NO.34

IBU HANI/FIKA KOORDINATOR 021-53664742| 53664743 N Y Y PARTIAL DENTAL [email protected]

355 0003 RS. TEBET JL. MT. HARYONO, NO.8, PANCORAN IBU.YATI MARKETING 021-8307540 / 829154| 021-8311760 Y Y Y ACTIVE ALL [email protected]/m

[email protected]

JAKARTA TIMUR

356 0024 KLINIK PRIMA HUSADA CIBUBURJL. LAPANGAN TEMBAK NO.2A

CIBUBUR

BPK. FAJAR DARS.

ONOKEUANGAN

021-

8708024/98111938/911193

8021-9111938|021-

9111938

021-87707503 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 13 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI357 0258 KLINIK DEVITA

JL. JATINEGARA TIMUR NO.57

JATINEGARADR. RUDI SUPRAPTO KEUANGAN

021-819 6260021-819

6041|021-819 6041

021-

85906901/851627

4

N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

358 0292 KLINIK PONDOK GEDE AGUNGJL. RAYA HANKAM, NO.58C-D, PONDOK

GEDEIBU ANJANI ADMINISTRASI 021-8464030| 021-8463803 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

om

359 0286 RS. KARTIKA PULO MAS JL. PULO MAS TIMUR K BLOK G-H-C/1 IBU. RAHAYUHUMAS &

MARKETING

021-4703333021-470

3333|021-470 3333021-4723402 Y Y Y ACTIVE ALL COVERAGE [email protected]

360 0806 RS. HAJI JAKARTA JL. RAYA PONDOK GEDENARIARTI HARDINI

(DINI)Div. Marketing

(021) 8000693-95(021)

8000695|(021) 8000695

021-

80876175/800015

2

Y Y Y ACTIVE ALL [email protected];am

[email protected]

361 0805 RSU. UKI JL. MAYJEN SOETOYO, CAWANG IBU PENI MARKETING

021-

8092317,8010526,8092831,

8010523|

021-

8092445/8005595Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

362 0807 KLINIK MHT TEGALAN JL. TEGALAN NO. 30 DR INDAH KOORDINATOR 021-8581344| 021-8581344 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

363 0779 RS. AU DR.ESNAWAN ANTARIKSAJL. MERPATI NO.2 LANUD HALIM

PERDANAKUSUMA

KAPT.BUDI

SANTOSOHUMAS (021) 8007027| (021) 8098 665 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

364 0382RB & KLINIK 24 JAM MHT PONDOK

GEDE D/H RS PONDOK G

JL. RAYA PONDOK GEDE, NO. 23-25,

KRAMAT JATIIBU HENNY MARKETING

021-

8093602/80887175/74|021-

80887175

021-80887174 N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]/yanee_

[email protected]

365 0652 RB & KLINIK AL - FAUZANJL. RAYA CONDET NO.13,

BALEKAMBANG CONDETBPK. FAIZ/ IBU PUR MARKETING 021-80886224| 021-8096968 N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

366 0749 RS. HARUM SISMA MEDIKAJL. TARUM BARAT, KALIMALANG

JAKTIMTARTO/ RATNA

MARKETING/KEUA

NGAN

021-8617212/3021-

8617213|021-8617213021-8601030 Y Y Y ACTIVE ALL COVERAGE [email protected]

367 0826 RB & KLINIK SEJAHTERA CIRACAS JL. RAYA CIRACAS NO.7 BPK.TURYANTO Humas

021-

87717635/87712710/87712

711-|-

021-87720232 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

368 2142 KLINIK PERTAMEDIKA RAWAMANGUN JL. MUNDU RAYA NO.1 JAKARTA TIMUR IRMA - 021-4894150| 021-4894278 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

369 1244 RS. MASMITRAJL. KELURAHAN JATIMAKMUR, NO.40,

PONDOK GEDEIBU WIWIT MARKETING 021-84971766| 021-8483047 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

370 2826 RS. COLUMBIA ASIA PULOMASJL. KAYU PUTIH RAYA, PULOMAS -

JAKARTA TIMUR 13210

ALI SABRI (021)

29559411 ; (0812

3850 2054)

MARKETING (021) 2945 9999| (021) 2955 9477 Y Y Y ACTIVE ALL COVERAGE [email protected]

371 3533 KLINIK MEDIKA PRAKARSAJL. RADEN INTEN II DUREN SAWIT,

JAKARTA TIMURBAPAK BAIHAQI MARKETING (021) 86908103| N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]/cs

@medikaprakarsa.co.i

372 0102RS. ISLAM JAKARTA TIMUR (PONDOK

KOPI)JL. RAYA PONDOK KOPI

IBU ALIUS/ BPK

ANGGORO

HUMAS/KEUANGA

N

021-8630654/8610471021-

8610471|021-8610471021-8611101 Y Y Y ACTIVE ALL COVERAGE [email protected]

373 1080 RS. KESDAM CIJANTUNGJL. MAHONI NO.1, CIJANGTUNG II

PASAR REBO JAKARTA TIMURBPK EGI ADM PERUSAHAAN

021-

8407886/8400535/8779333

2-|-

021-87793332 Y Y Y ACTIVE ALL [email protected]

om

374 2643 KLINIK & APOTEK KF 49JL. P. REVOLUSI 53, PD. BAMBU,

JAKARTA TIMUR

ANISA IKA

RAHMANIAH,

S.FARM., APT.

- 021 861-5154| 021-8612721 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

375 3980 KLINIK & APOTEK KF 48JL. MATRAMAN RAYA NO 55 JAKARTA

TIMURWAYAN SUTAKA - 0818810414| N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

376 3981 KLINIK & APOTEK KF LAP.TEMBAKJL. LAWU B1 NO.1 CIBUBUR LAPANGAN

TEMBAK CIBUBURNASTIA HIDAYATI - 08128737346| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

377 3531 SUMATERA EYE CENTER JAKARTAJL. PEMUDA NO. 36, RAWAMANGUN,

JAKARTA TIMUR

CITRA KARINA

PUSPITA LOKAMARKETING (021) 4714848| (021) 4755703 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

378 1932 APOTEK KIMIA FARMA 193JL. UTAN KAYU NO 105 P JAKARTA

TIMURROSMIDA KHOHAR APOTEKER 021-8520808| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

379 1933 APOTIK FARMARIN II PENGGILINANPERUM TAMAN PULO INDAH BLOK I

NO.7-8 PENGGILINGAN CAKUNGIBU NILA/ SUPRI - 021-4800688| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

380 2251 RS. ANTAM MEDIKAJL. PEMUDA RAYA NO 1A PULOGADUNG

JAKARTA TIMUR

IBU SRI AGUSTI

NINGSIHmarketing 021- 29378939/40/44| 021- 29385160 Y Y Y ACTIVE ALL COVERAGE [email protected]

381 2141KLINIK PERTAMEDIKA MEDAN

SATRIA

JL. ARUN IX NO. 2 MEDAN SATRIA

CAKUNG JAKARTA TIMUR 17132KIKI SM - 021-4604944| N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

;[email protected]

382 2391 RS. JANTUNG JAKARTAJL. MATRAMAN RAYA NO.23, JAKARTA

TIMUR

SUCI

TRIHANDAYANI-

021-

29361158/29361160/29360

698|

2129361158 Y Y Y ACTIVE ALL COVERAGE [email protected]

383 2620 KLINIK & APOTEK KF 4 JL. PERSERIKATAN 7-8, RAWAMANGUN

RUMONDANG

MARIA, S.FARM.,

APT.

- 021 471-8059| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 14 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI384 2638 KLINIK & APOTEK KF 147 JL. DUREN SAWIT

DRS. ADI

SUPRIYADI, APT.- 021 861-5458| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

385 1490 RSIA. BUNDA ALIYAHJL. PAHLAWAN REVOLUSI NO.100

PONDOK BAMBU

IBU ENDANG/PAK

SANDYMARKETING 021-86602525| 021-86600712 Y Y Y ACTIVE ALL COVERAGE

marketing.rsiabundaaliyah@gma

il.com

386 0060 RS. HARAPAN BUNDA JL. RAYA BOGOR KM.22 NO.44 ITA/ENDAH MARKETING 021-8400257|

021-

8412977/8778020

1

Y Y Y ACTIVE ALL [email protected]

m

387 0888 RS. YADIKA PONDOK BAMBUJL. PAHLAWAN REVOLUSI NO.47

PONDOK BAMBU - JAKARTA TIMURIBU TETTY MARKETING

021-8615754021-

8610756|021-8610756021-8613332 Y Y Y ACTIVE ALL COVERAGE

[email protected]/rs

[email protected]

388 0289 RS. OMNI MEDICAL CENTER JL. PULO MAS BARAT VI, NO.20 BPK. AMRI MARKETING 021-4723332,4722719|021-

4718081,4708180Y Y Y ACTIVE ALL COVERAGE

mktpulomas@omni_hospitals.co

m;

389 0012RS. PREMIER JATINEGARA ( RS

MITRA INTERNASIONAL)JL. RAYA JATINEGARA TIMUR, NO.85-87 IBU RENI/drg. widya MARKETING

021-2800666/2800888|021-

2800777021-2800755 Y Y Y ACTIVE ALL COVERAGE

rspremier.jatinegara@ramsayhe

alth.co.id;

390 1868RSIA. AL-FAUZAN (JAKARTA ISLAMIC

HOSPITAL)

JL. PEDATI NO 3 RT 5 RW 7, KAMPUNG

TENGAH KRAMAT JATIIBU NIA MARKETING 021-87780318| - Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

391 1843 RSIA. SAYYIDAHJL. TAMAN MALAKA SELATAN NO. 6

PONDOK KELAPA, JAKARTA TIMUR

BPK RAMA/ BPK

BERTOMARKETING (021) 8690 2950| (021) 864 9886 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

392 1012 KLINIK IBIN SINAJL. PENDIDIKAN RAYA NO.33 DUREN

SAWITIBU DEWI MARKETING

021- 866 03270, 866

1669021-86603270|021-

86603270

86601611 N Y Y ACTIVE ALL COVERAGE [email protected]

393 0944RS. BHAYANGKARA TK.1 R.SAID

SUKANTO (POLRI)JL. RAYA KRAMAT JATI IBU RATNA MARKETING 021-8093288-|- 021-8094005 Y Y Y ACTIVE ALL COVERAGE

394 0948 KLINIK SAPTA MITRAJALAN TAMAN MALAKA UTARA BLOK

A12, MALAKAJAYABAPAK DEDI MARKETING

021-86906363021-

5844330|021-5844330021-86906363 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

marketing_saptamitraklinik@yah

oo.co.id

395 0099 RS. HARAPAN JAYAKARTAJL. BEKASI TIMUR RAYA, NO.6 KM.18,

PULO GADUNGIBU LISA MARKETING

021-4603916/4601371021-

46822879|021-46822879021-4608863 Y Y Y ACTIVE ALL COVERAGE

[email protected];har

[email protected]

396 0386 RSIA. HERMINA JATINEGARA JL. RAYA JATINEGARA BARAT, NO.126 IBU DESY MARKETING021-8191223021-

8504371|021-8504371021-8190111 Y Y Y ACTIVE ALL COVERAGE

jatinegara@herminahospitalgrou

p.com

397 1001 RS. DHARMA NUGRAHAJL. BALAI PUSTAKA BARU NO.19

RAWAMANGUNRANI ADM

021-4707433-37021-

4707437|021-4707437021-4707429/8 Y Y Y ACTIVE ALL COVERAGE

[email protected]/sap

[email protected]

398 1139 KLINIK TJAKRAJL. RAYA BOGOR, KM.24, NO.35,

SUSUKAN CIRACASBPK.ANGGA MARKETING 021-8401677|

021-

87792558/840167

7

N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];tribudi63

@yahoo.co.id

399 1192 KLINIK & APOTEK PUTEWAJL. NUSA INDAH RAYA BLOK 40

NO.17HIBU LATIVA ADM 021-8622207/70302043| 021-8622207 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

400 0962 KLINIK CONDET JAYA JL. CONDET JAYA NO.18 BATU AMPARIBU SUSI/BAPAK

WARNOMARKETING 021-8090712|- 021-80881275 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

401 0990RS. JANTUNG BINA WALUYA

CARDIAC CENTERJL. TB SIMATUPANG NO.71 IBU SIFA MARKETING

021-87781605-06021-

87781606|021-87781606021-8403869 Y Y Y ACTIVE ALL COVERAGE

[email protected];ma

[email protected]

402 1110 RSIA. RESTI MULYAJL. PAHLAWAN KOMARUDIN RAYA NO. 5

PENGGILINGAN CAKUNGBPK. ABDILAH MARKETING

021-4803936-4802192-

4803707|021-48701488 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

403 1212 KLINIK BINA HUSADA BHAKTIJL. PENGGILINGAN RAYA NO.1

RT.01/07 CAKUNG

BPK.WAWAN/IBU

INDRIMARKETING 021-46829425| 021-46829425 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

o.id

404 1217 RSIA. RESTU KASIHJL. RAYA BOGOR, KM.19, NO.3A,

KRAMAT JATI

IBU OKTAVIA

LINGGAR

PIMPINAN/KOORDI

NATOR021-8002166/8001177| 021-80882753 Y Y Y ACTIVE ALL COVERAGE [email protected]

405 1096 KLINIK YADIKA CIBUBURJL. LAPANGAN TEMBAK NO.9 PEKAYON-

CIBUBURIBU RINI MARKETING 021-8711515-|- 021-8711515 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

406 1258 KLINIK SUCI HUSADAJL. SUCI NO.21 RT.08/06 SUSUKAN -

CIRACASDR.EDDY PEMILIK 021- 87798796| 021- 87798796 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

407 1262 RS. RAWAMANGUN JL. BALAI PUSTAKA RAYA, NO.29-31 BPK. RIZAL MARKETING 021-4893531| 021-4710918 Y Y Y ACTIVE ALL COVERAGE [email protected]

408 1538KLINIK MITRASANA (DANKOS

FARMA)

JL. RAWA GATEL, BLOK IIIS, KAV.37-

38, KAW.INDUSTRI PULO GADUNGIBU HELDA KOORDINATOR 4600158/4600157| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

409 1499 RB & KLINIK ANNISA CIRACAS JL. CIRACAS NO.18 IBU BETRIDA / KOORDINATOR 021-87720807| 021-87717636 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

410 0122 RS. MEDIROS JL. PERINTIS KEMERDEKAAN, KAV.149BPK UKAS/IBU TIA

/ BPK RAHMANMARKETING

021-

4750042/4897415/4893036

/4895817/4721237021-

4893036|021-4893036

021-4891937 Y Y Y ACTIVE ALL [email protected]/rs-

[email protected]

JAKARTA UTARA

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 15 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI411 3998 KLINIK PESONA TANAH PASIR

JL. TANAH PASIR RUSUN PENJARINGAN

BLOK MAWAR I A

KEL.PENJARINGAN,KEC.PENJARINGAN,

JAKARTA UTARA

DR. EDDY OWNER021-

66675691/085101280470|- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

412 0170 RS. PLUIT JL. RAYA PLUIT SELATAN, NO. 2IBU MIAN/BPK

TAUFIK/DR.JOVITAMARKETING

021-6685006; 021-

668507|021-668507021-6684878 Y Y Y ACTIVE ALL COVERAGE

humas_marketing@pluit/marketi

[email protected]

413 2143 KLINIK PERTAMEDIKA DELIJL. DELI NO. 22 JAKARTA UTARA - 1-

628

SYAHRUL

(081511520327)- 021-43923390 / 3389| 021-4353461 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

414 4079 RS. DUTA INDAH JL. TELUK GONG RAYA NO 12 WISNU PRABOWO - (021) 666 7 6188| (021) 6667 6190 Y Y Y ACTIVE ALL COVERAGE [email protected]

415 1946 APOTEK KIMIA FARMA 46 JL. YOS SUDARS. O, JAKARTA UTARA - - 021-4393397| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

416 2412 KLINIK BERSALIN LESTARI

JL. MANGGAR NO.141 KEL.LAGOA,

KEC.KOJA TANJUNG PRIOK JAKARTA

UTARA

BAMBANG - 021 43922950| - N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

-

417 2458 RSIA. GRAND FAMILY

JL. PANTAI INDAH SELATAN 1,

KOMPLEK ELANG LAUT BOULEVARD

KAV.1 NO.1, PENJARINGAN - JAKARTA

UTARA

IBU MYLLA

NASUTION-

021-

296333777/02129673737

DAN 29678062|

- Y Y Y ACTIVE ALL COVERAGEmylla.nasution@rsiagrandfamily.

com

418 2506 MITRASANA KELAPA GADING

JL. BOULEVARD TIMUR RAYA BLOK NB

I NO 36 KELURAHAN PEGANGSAAN

DUA, KELAPA GADING JAKARTA UTARA

- - 021-36464908/4585455| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

419 1550 RS. PURI MEDIKAJL. SUNGAI BAMBU RAYA, NO.5,

TANJUNG PRIOK

BPK SUBHAN/IBU

DINAMARKETING 021-43903355/43931975| 021-43903388 Y Y Y ACTIVE ALL COVERAGE [email protected]

420 1677KLINIK SOLA GRACIA MEDICAL

CENTER

JL. SUNTER AGUNG UTARA BLOK A 17

D NO 1DRG. BETTY PEMILIK 021-6459530/6452041|

021-6459530;

6451274N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

421 1746 LAB. KLINIK BIOTEST PLUITJL. PLUIT SAKTI RAYA NO 25 JAKARTA

UTARAVIVI/RATRI - 021-6622611| 021-6628166 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

[email protected]

422 1644 KLINIK SYIFA MEDICAL CENTREJL. LONTAR LUAR NO.7 RT 004/04

TUGU UTARA KOJAIBU NURUL MARKETING 021-43935260| 021-43935375 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

423 0876 RSIA. FAMILY

JL. PLUIT MAS I BLOK A NO.2A-5A,

KOMPLEK PERUMAHAN PLUIT MAS,

JAKARTA UTARA

IBU RERE MARKETING021-6695066/6694990021-

6694990|021-6694990

021-

6615563/6660725

4

Y Y Y ACTIVE ALL [email protected]/

[email protected]

424 1033 RS. PORT MEDICAL CENTER JL. ENGGANO NO.10 TANJUNG PRIOK IBU RIZKA MARKETING 021-43902350/43902351-|- 021-43902302 Y Y Y ACTIVE ALL COVERAGE [email protected]

425 0919 RS. PELABUHAN JAKARTA JL. KRAMAT JAYA, TANJUNG PRIOK DR.SELVI MARKETING 021-4403026|021-4403026021-

4403551/4406886Y Y Y ACTIVE ALL COVERAGE [email protected]

426 0392 RSIA. HERMINA PODOMOROJL. DANAU AGUNG 2, BLOK E3, NO.28-

30, SUNTER AGUNG, PODOMOROIBU KRISTIN/ENI MARKETING 021-6404910/911| 021-6518720 Y Y Y ACTIVE ALL COVERAGE

podomoro@herminahospitalgrou

p.com

427 0587 RS. SATYA NEGARA JL. AGUNG UTARA RAYA, BLOK A, NO.1DR. TONI

081399999870Marketing

021-64715200021-687813-

14/6|021-687813-14/6021-6877813 Y Y Y ACTIVE ALL COVERAGE

[email protected]/adh

ytiadr.satyanegara@gma

428 1263 KLINIK SEMPER SISMA MEDIKAJL. KESEMEK, NO.3-5, SEMPER BARAT,

CILINCINGBPK. AHYAT Kep Adm & Keu 021- 4400902/4403101| 021-4403101 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

429 1269 RS. MULYASARIJL. RAYA PLUMPANG SEMPER NO. 19

JAKARTA UTARADR. RIANA ZULFA

KABAG BID.

PELAYANAN

021-43931111-43936666-

43939999|

021-

43934369/8888Y Y Y ACTIVE ALL COVERAGE

[email protected];rs.

[email protected]

430 1422 ROYAL PROGRESS INT HOSPITALJL. DANAU SUNTER UTARA, SUNTER

PARADISE IIBU NEVI

SALES

KOORDINATOR021- 6400261| 021-6519534 Y Y Y ACTIVE ALL COVERAGE [email protected]

431 0186RS. MITRA KELUARGA KELAPA

GADING

JL. BUKIT GADING RAYA KAV.2 KELAPA

GADING PERMAI

DR. ANNY

ALFIANTI/IBU

MAYA/IBU DELLA

MARKETING 021-45852700|

021-

45852727/458540

4

Y Y Y ACTIVE ALL [email protected];keua

ngankg@mitrakeluarga.

432 0812 RS. ATMA JAYA JL. PLUIT RAYA NO.2 IBU HAPPY MARKETING (021) 6606127| (021) 6606122 Y Y Y ACTIVE ALL COVERAGEmarketingpr@atmajaya-

hopital.co.id

433 0811 RS. SUKMULJL. TAWES NO.18 - 20, TANJUNG

PRIOKIBU YUNI/ BP PINTO MARKETING 021- 4301269| 021- 4301272 Y Y Y ACTIVE ALL COVERAGE [email protected]

434 0396 RS. PANTAI INDAH KAPUKJL. PANTAI INDAH UTARA 3, PANTAI

INDAH KAPUK

IBU

DESAK/NELLA/FITRI

MARKETING/ASUR

ANSI021-5885066; 5885065|

021-

5880910/5881091Y Y Y ACTIVE ALL COVERAGE [email protected]

435 0882 RS. ISLAM JAKARTA UTARAJL. TIPAR CAKUNG NO.5 JAKARTA

UTARA

IBU DINA/DRG.

RENITAMARKETING

021-4400781,4400778021-

4400778|021-4400778

021-

44832228,440078

2

Y Y Y ACTIVE ALL COVERAGE [email protected]

GORONTALO

436 1420 RSIA. SITTI KHODIJAH GORONTALOJL. NANI WARTABONE NO. 101 d/h JL.

AHMAD YANIIBU NURHAYATI MARKETING

0435-821258/0435-

821253/0435-824410|0435-824410 Y N Y ACTIVE ALL COVERAGE [email protected]

JAMBI

437 2207 RSU. BAITURRAHIM JAMBIJL. PROF. M. YAMIN SH NO. 30 LEBAK

BANDUNG - JAMBIIBU RINI PROVITA Marketing

0741-35165/0741-

5911096/97/98|0741-5911099/97 Y Y Y ACTIVE ALL COVERAGE

[email protected].

id; rsu_baiturrahim@y

GORONTALO

JAMBI

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 16 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI438 2047 RSIA. ANNISA JAMBI

JL. KABIA NO 04 RT 01 KEL. KEBUN

HANDIL KEC JELUTUNG KOTA JAMBIM. SALEH - (0741) 445226| - Y Y Y ACTIVE ALL COVERAGE [email protected]

439 0894SILOAM HOSPITALS JAMBI (D/H RS.

ASIA MEDIKA)

JL. SOEKARNO - HATTA, PAALMERAH

JAMBI

BP TUNGGUL PURB.

AMARKETING 0741-5919000-|-

0741-

573271/573238Y Y Y ACTIVE ALL COVERAGE

Tunggul.Purba@siloamhospitals.

com

440 2184 APOTEK KIMIA FARMA 208 JL. SOEMANTRI BROJONEGORO NO. 1BPK. MURS. YID

(APOTEKER-

08877800501/08214638327

5|- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

441 1641 RS. ISLAM ARAFAHJL. EMPU GANDRING NO.1 KEBUN

JERUK, JAMBI

IBU DELLA/ IBU

ICHAMARKETING 0741-62711/667966/62177| 0741-63444 Y Y Y ACTIVE ALL COVERAGE [email protected]

442 0550 RS. ST.THERESIA JL. SUTOMO, NO.19

IBU

RENDA/BPK.YOHANE

S/IBU HERTI

KEUANGAN 0741 - 23119 / 7553811| 0741-20832 Y Y Y ACTIVE ALL [email protected];

[email protected]

MUARA BUNGO

443 1926 RS. SENTRAL MEDIKA MUARA BUNGOJL. RANGKAYO HITAM, CADIKA MUARA

BUNGO, JAMBIUMI MARKETING 0747-22207/22209| 0747-22209 Y Y Y ACTIVE ALL COVERAGE [email protected]

BANDUNG

444 0761 RS. SANTO BORROMEUS BANDUNG

JL. IR. H. JUANDA NO. 100 LEBAK

GEDE COBLONG BANDUNG JAWA

BARAT, INDONESIA

IBU RIA/

ESKARINA/IBU DEVI

/ IBU KARIN/ DWI

TANIA

MARKETING

022 2552166/022-

2552083/95022-

2552003|022-2552003

022-2504235 Y Y Y ACTIVE ALL COVERAGE [email protected]

445 1125 RS. CAHYA KAWALUYANJL. PARAHYANGAN KM.3 KAV.HOS

PADALARANG

IBU ERLINAWATI/

MERRYMARKETING 022-6803700|

022-

6803711/6803730Y Y Y ACTIVE ALL COVERAGE

[email protected]/rlint

[email protected]

446 2950 RS. KB. MELINDA II

JL. CIPTO NO. 1 RT 05/02, KEL.

PASIRKALI KEC. CICENDO, KOTA

BANDUNG

BAPAK REMY - 022-4267888/4233777| 022-4247888 Y Y Y ACTIVE ALL COVERAGE [email protected]

447 3001 LAB. KLINIK BIOTEST NARIPAN JL. NARIPAN NO. 41 BANDUNG IBU YAYAH MARKETING (022) 4205544| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

448 1211 KLINIK ASRI HUSADA II JL. TITIRAN NO.16 DR.YONO PIMPINAN 022-2507293| 022-2507293 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

449 1169 RS. AMC (ANNISA MEDICAL CENTER) JL. RAYA CILEUNYI RANCAEKEKIBU DARA / IBU

DEWIMARKETING

022-

7781630,70804777,708057

77|

022-

70804777/778162

9

Y Y Y ACTIVE ALL [email protected]/www.amc

hospital.blue.orb.biz

450 1171SANTOSA BANDUNG INTERNASIONAL

HOSPITALJL. KEBON JATI, NO.38

MIRA/ANDRI/MIRZA

/MARKETING 022-4248333|

022-

4211086/8446859

8

Y Y Y ACTIVE ALL COVERAGEandri_subekti@santosa-

hospital.com

451 0958 KLINIK AN-NUR JL. DR. SETIA BUDI NO.63 IBU YOSI MARKETING 022-2031922-|-022-

2031922/2042213N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

452 0959 KLINIK ASRI HUSADA I JL. BEKAMIN NO.18 BPK.SURYADI KOORDINATOR 022-7230425-87245792|- 022-2507293 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

453 1088 RS. RAJAWALI JL. RAJAWALI NO.38 BPK. SOFYAN ADMINISTRASI022-6031087, 6011913,

6079143,6051087-|-022-6032077 Y Y Y ACTIVE ALL COVERAGE [email protected]

454 1093RS. KHUSUS BEDAH HALMAHERA

SIAGAJL. LL.RE MARTADINATA NO.28

BESTI YULIANA

S.KM

Humas dan

Marketing

022-

4206061/70858254/421643

6-|-

022-4236920 Y Y Y ACTIVE ALL COVERAGE [email protected]

455 0145 RS. MUHAMMADIYAH BANDUNG JL. KH. AHMAD DAHLAN NO.53 BPK.WAWAN MARKETING

022-

7301062,7312167,7323549,

7306935,7323548|

022-7306458 Y Y Y ACTIVE ALL COVERAGE

[email protected]/

rsmuhammadiyahbandung53@y

a

456 0886 RSUD. AL IHSAN JL. KIASTRAMANGALA, BALEENDAH,

IBU

DEUCE/BPK.SUTISN

A

HUMAS &

PEMASARAN

022-

5940872/5941719/5941729

022-5941719|022-5941719

022-5941709 Y Y Y ACTIVE ALL COVERAGE [email protected]

457 0877 KLINIK & APOTEK KIMIA FARMA 10 JL. BRAGA, NO.2-4-6BPK.MURS. YID/ IBU

YULIANISEKRETARIAT 022-4233185-|- 022-4203565 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

458 1829 RSIA. LIMIJATI JL. LAKS L RE MARTADINATA 33-39 IBU MEIKE Marketing 0224207770| 0224-4260956 Y Y Y ACTIVE ALL COVERAGE [email protected]

459 1170 RS. SANTO YUSUP JL. CIKUTRA 7 BANDUNGIBU DIAH/ BPK

HENDROMARKETING

022-7208172,022-7217097,

022-7217103, 022-

7231721|

022-7202419 Y N Y ACTIVE ALL [email protected]

d

460 2166 APOTEK FARMARIN BANDUNGJL. KH AHMAD DAHLAN (JL. BANTENG)

NO 62, BUAH BATU

DRA. SRI

WULANDARI, APTAPOTEKER 022-7300660| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

461 2167APOTEK FARMARIN BANDUNG 2

TUBIS

JL. TUBAGUS ISMAIL NO.79 RT/RW

004/012 KEL.SEKELOA KEC. COBLONG

BANDUNG

ARI PRIHANTINI,

S.SI, APTAPOTEKER 022-2500387| 022-2517116 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

462 0044 RSIA. HERMINA PASTEURJL. DR. DJUNDJUNAN, NO.107,

PASTEURIBU ANI / BP TANTO

MARKETING

KABAG022-6072525| 022-6037815 Y Y Y ACTIVE ALL COVERAGE

marketingpasteur@herminahospi

talgroup.com

463 1568 KLINIK UTAMA MONALISA JL. MOCH. RAMDHAN NO.32 IBU TINA MARKETING 022-5211311| 022-5200162 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

monalisa.medical.centre@gmail.

com

464 1087 RS.BUNGSU JL. VETERAN, NO.6 IBU ELLY MARKETING 022-4231550-|- 022-4231582 Y Y Y ACTIVE ALL COVERAGE [email protected]

JAWA BARAT

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 17 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI465 0144 RS. IMMANUEL BANDUNG JL. KOPPO, NO.161 IBU.NYOMAN MARKETING

022-

5201051/5201672/5224216

022-5224216|022-5224216

022-5224219 Y Y Y ACTIVE ALL [email protected];

[email protected]

466 1687 RS. IMC

JL. RAYA CIAMREME NO 170-173

NGAMPRAH, PADALARANG, BANDUNG

BARAT

DR. ARI / BAPAK

ASEPMARKETING 022-6620923/6620965| 022 - 6620964 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

467 1265APOTEK KIMIA FARMA SULAJANA (KF

51)JL. SULAJANA NO. 24

IBU YETHI/DRS.

CHANDRA

HARIBOWO,APT

KOORDINATOR 022-91512935| 022-4261088 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

468 1515 RS.MELINDA JL. PAJAJARAN, NO.46 IBU RAISYA / INDAH MARKETING

022-

4222788,4222388,4209088,

4266700|

022-4215700 Y Y Y ACTIVE ALL [email protected];

[email protected];

469 3366 SANTOSA HOSPITAL BANDUNG KOPOJL. K.H. WAHID HASYIM (KOPO),

NO.461-463 BANDUNG

IBU DISTIA/DR.

ANGGIE

ARIANDHITA

Marketing 022-54280333|

022-

5402242/5428036

5

Y Y Y ACTIVE ALL COVERAGEdistia.puspitasari@santosa-

hospital.com;

470 2734 RSU. PINDADJL. JEND. GATOT SUBROTO NO.517

(PAPANGGUNAN) BANDUNG 40285ALLIN PERAMA MARKETING 022-7322877/7309807| 022-7322468 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

471 2730 KLINIK & APOTIK K-24 JL. LASWI NO.1A,BANDUNGASTI YUNIA

(085861868000)(022) 7821700/7215992| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

472 2704 KLINIK & APOTEK KF 43 JL. BUAH BATU, BANDUNGDRS. MUHAMMAD

HILMI,APT- 022 7305019| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

473 2705 KLINIK & APOTEK KF 320 JL. CINUNUK NO.192, BANDUNG TATI SUHARTATI - 022 7801875| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

474 2719 KLINIK JAYA SENTOSA JL. SUNDA NO.75, BANDUNG

CHARLES (022-

70988880) / LINE

ROSTATI (022-

9264161

- 022 426 4258| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

475 2720KLINIK JAYA ABADI ( GROUP JAYA

SENTOSA)JL. BUAHBATU NO.245 , BANDUNG

CHARLES (022-

70988880) / LINE

ROSTATI (022-

9264161

- (022) 730 4273| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

476 0303 RS. ADVENT BANDUNG JL. CIHAMPELAS, NO.161 BPK. YUDHI MARKETING 022 -2034386-9/2034388|022-

2043167/2041109Y Y Y ACTIVE ALL COVERAGE [email protected];

477 1578 RS. HERMINA ARCAMANIKJL. AH.NASUTION, KM.7, NO.50,

ARCAMANIK BANDUNGRINI HANDAYANI MARKETING 022-87242525| 022-7271771 Y Y Y ACTIVE ALL COVERAGE

arcamanik@herminahospitalgrou

p.com

478 2625 KLINIK & APOTEK KF 12 JL. IR H JUANDA NO1 BANDUNG BPK MULYADIPENANGGUNG

JAWAB022 4205421| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

479 2626 KLINIK & APOTEK KF 14 JL. CIAMPELAS 7, BANDUNG ONO DARS. ONOPENANGGUNG

JAWAD022-4201596| N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

480 2622 KLINIK UTAMA AL-ISLAMJL. AWIBITUNG NO.29 CICADAS

BANDUNG 40121

M. SAEFULLOH

HASAN- (022) 7208284| (022) 7276149 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

481 3588 KIMIA FARMA SINDANGLAYA JL. AH.NASUTION NO.126 B LEA OKTAVIANI Apoteker 0227278664| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

482 3589 KIMIA FARMA 319 METRO JL. VENUS RAYA NO 27 - - 0227564623| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

483 3591 APOTEK KIMIA FARMA 381 KOPO JL. KOPO CIRANGRANG NO.638 - - 0225436596| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

484 3592 KIMIA FARMA SETIABUDI JL. DR.SETIABUDHI NO 36, BANDUNG HANI NOVIANI - 0222038048| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

BANJARBEKASI

485 1517 RSU. DR. ADAM TALIB JL. TEUKU UMAR, NO.25, CIBITUNG IBU. SULIS Marketing 021-88332305/06| 021-88332308 Y Y Y ACTIVE ALL COVERAGE [email protected]

486 1277 RB & KLINIK GUCI MEDIKA JL. PRAMUKA NO.79 RAWA LUMBU BP ARIF MARKETING 021-82433158| 021-8221921 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

487 1293 KLINIK YAKESTI BEKASIJL. RAYA NAROGONG KM.7 NO.45

BOJONG MENTENGBPK. ARIEF MARKETING -021 8253516| - N Y Y ACTIVE ALL COVERAGE -

488 1296 RSB. TAMAN HARAPAN BARUJL. TAMAN HARAPAN BARU RAYA, BLOK

R-I,NO.20,PEJUANG MEDAN SATRIAIBU MERRY MARKETING 021-88871202| 021- 88871203 Y Y Y ACTIVE ALL COVERAGE [email protected]

489 1304 RSIA. PUSPA HUSADAJL. RAYA PONDOK TIMUR KM. 1, NO 27

JATIMULYA TAMBUN SELATAN-BEKASIBPK. EDI SUTIKNO MARKETING 021-82618978/82618979| 021-82618977 Y Y Y ACTIVE ALL COVERAGE [email protected]

490 1333 RSU. KARTIKA HUSADA JATIASIHJL. SWANTARA NO 72 JATI ASIH,

BEKASIIBU EMIL - 021-82435585-82435587| 021-82435586 Y Y Y ACTIVE ALL COVERAGE [email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 18 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI491 1530 KLINIK SIERRA MITRA

JL. KH. M.TABRANI BLOK I NO. 1 A-1B,

MARGAMULIA, BEKASI UTARABPK. KRISNA MARKETING 021-70266392/8868129| 021-8868129 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

492 1541 RS. PERMATA BEKASIJL. LEGENDA RAYA, NO. 9, MUSTIKA

JAYA

DRG.RIMA/BPK.

ASEPMARKETING 021-8251919/8254748| 021-82609705 Y Y Y ACTIVE ALL COVERAGE [email protected]

493 1559 RB & KLINIK TIARA BUNDAJL. RAYA PERJUANGAN NO. 1,

PERTIGAAN TELUK PUCUNGDR.LINDA KOORDINATOR 021-89131010| 021-89131010 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

-

494 1122 RS. JATI SAMPURNA JL. STUDIO ANTV KRANGGAN DRG. IKHWAN PANE MARKETING 021-8451457| 021- 8455712 Y Y Y ACTIVE ALL COVERAGE [email protected]

495 1576RS TAMAN HARAPAN BARU (d/h

praktek bersama dokter)

JL KALIABANG TENGAH RT 04/23 KEL.

PEJUANG KEC. MEDAN SATRIAIBU YESSI FRISELLA MARKETING 021-88981055| 021-88981055 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

496 1038 KLINIK HARAPAN SEHAT IIIPERUMAHAN VILLA MUTIARA JAYA,

BLOK MB 16/7, CIBITUNGDR.ERNA KOORDINATOR 021- 68295994/88393875-|- - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

497 0947 RS. APRILIA MEDIKAJL. RAYA SETU NO.99 DESA LUBANG

BUAYA, KEC SETU BEKASIBPK. AFNAN RIFAI MARKETING

021 - 82611565021-

5901312|021-5901312021 - 82611565 Y Y Y ACTIVE ALL COVERAGE [email protected]

498 0949BP DR. SANDER B(D/H KLINIK

HOSANA MEDICA CIBITUNG)JL. TEUKU UMAR NO.19 CIBITUNG DR PETER KOORDINATOR 021-8833 8414-|- 021-8833 8413 N Y Y ACTIVE ALL COVERAGE

499 0950KLINIK HOSANA MEDICA MANGUN

JAYA (HOSANA MEDIKA IV

JL. MANGUN JAYA INDAH II BLOK G10

NO. 3 TAMBUN BEKASI 17510DR HENY KOORDINATOR (021) 8832-0349-|- (021) 8832-0349 N Y Y ACTIVE ALL COVERAGE

500 1051RB & KLINIK ANGELIKA (RB.

DEBORAH)

PERUMAHAN PONDOK TANAH MAS JL.

BOSIH RAYA BLOK E15 NO.12-13

CIBITUNG

BIDAH DEBORAH PEMILIK 021-88330750-|- - N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

-

501 1053 RS. ST. ELISABETH - BEKASIJL. RAYA NAROGONG NO.202 KEMANG

PRATAMA

BPK. ANTON/IBU

YUNIMARKETING/KEU

021-

82430101/82432949/82400

186/8229767021-

82432082|021-82432082

021-82432083 Y Y Y ACTIVE ALL COVERAGE [email protected]

502 0622 RSU. MITRA MEDIKA

JL. DESA JATIWANGI-

CIKEDOKAN/SEBELAH SELATAN

KAWASAN MM 2100 KP KAMURANG RT

1/1 CIKEDOKAN, CIKARANG BARAT

BP.H. MINDA S PEMILIK021-8998

3741/71691709/98213879|021-89983575 Y Y Y ACTIVE ALL COVERAGE [email protected]

503 0588 KLINIK MELVIANAJL. SAPARUA RAYA NO.239 - 240

PERUMNAS III BEKASIIBU YULINDA Marketing 021-8807610 / 88354744| 021-88341291 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

504 0036 RS. SENTOSAJL. PAHLAWAN, NO.60 DUREN JAYA,

BEKASI TIMURIBU SARI MARKETING 021-880 6140| 021-881 4950 Y Y Y ACTIVE ALL COVERAGE [email protected]

505 0324 RS. GRAHA JUANDA JL. IR. H. JUANDA, NO.326 IBU PUJI MARKETING021- 8811832,8821004021-

8811832|021- 8811832021 - 88346880 Y Y Y ACTIVE ALL COVERAGE [email protected]

506 1140 RS. RAWA LUMBUJL. DASA DARMA, NO.20-23, RAWA

LUMBUBAPAK AGUS Marketing 021-82422511| 021-82432958 Y Y Y ACTIVE ALL COVERAGE [email protected]

507 0974 KLINIK MITRA MEDIKA JL. AGUS SALIM NO. 173 IBU SETYO KOORDINATOR021-8802886/ 021-8802886-

|-021-8802457 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

508 0982 RS. BUDI LESTARIJL. KH.NOER ALIE, NO.2 DEPAN

PERUMNAS II, KALIMALANGIBU JULIA MARKETING

021-8842336/8893486021-

8893486|021-8893486021-8893487 Y Y Y ACTIVE ALL COVERAGE

[email protected]

o.id

509 0987RB & KLINIK HARAPAN SEHAT

CIBITUNGJL. TEUKU UMAR NO.33 CIBITUNG IBU RIA MARKETING 021-88336674-|- 021-8901126 N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

510 0988 RS. PERMATA BUNDA BEKASIPERUM GRAMAPURI TAMANSARI C1/8-

10 CIBITUNG

BPK ROKIB/BPK

HARIRIKOORDINATOR 021-88328001/88392537-|- 88328002 Y Y Y ACTIVE ALL COVERAGE

marketingrspb@permata-

bunda.com/marketing_rspb@ya

h

511 1120 KLINIK PURI NUSAPHALAJL. CITRA INDAH A/14 PERUM PURI

NUSAPALA JATI ASIHBPK.TEGUH MARKETING 021-82440368/7| 021-82440368 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

512 1123 RS. CITRA HARAPAN

JL. RAYA HARAPAN INDAH

KAW.SENTRA NIAGA NO.3-5 MEDAN

SATRIA

IBU DEWI MARKETING

021-

88870606/88870909/88865

792-93|

021-88975555 Y Y Y ACTIVE ALL COVERAGE [email protected]

513 1206 KLINIK SADRINA MEDIKA II

JL. PERUM BEKASI TIMUR REGENSI

BLOK.H2 NO.12, KEL.CIMUNING,

BEKASI TIMUR

IBU ANI Koordinator021-82612828 /

081212103703|- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

514 1207 KLINIK DIPONEGORO JL. DIPONEGORO NO.26 TAMBUN IBU VIVI KOORDINATOR 021 - 8817062| 021-88346743 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

515 1216 RS. JUWITA JL. M. HASIBUAN NO.78 - BEKASI Ibu Nia MARKETING 021 -8829590/1| 021-8829592 Y Y Y ACTIVE ALL COVERAGE [email protected]

516 1136 KLINIK PERMATA BUNDA BEKASIJL. BOSIH RAYA RUKO KARTIKA

WANASARI BLOK.C1/4 CIBITUNGBAPAK ROKIB Koordinator

021- 88373158 / 021-

88328001/ 88392537|- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

517 1090 RS. PERMATA CIBUBURJL. ALTERNATIF CIBUBUR - CILEUNGSI

NO.6A BEKASI

IBU

MARLINA/RIYANIMARKETING, CS 021-8458806-|- 021-84592146 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m; rianicleopatra@yah

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 19 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI518 1259 KLINIK WIJAYA KESUMA

JL. NAROGONG SAKTI RAYA BLOK A 20

NO.1IBU FARISYAH KOORDINATOR 021 - 8210779| 021 - 8226455 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

519 0010 RS. MITRA KELUARGA BEKASI BARAT JL. JEND. A.YANI, BEKASI BARAT IBU TITI MARKETING 021-8853333|021-

8842550/8855000Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

520 0032 RB. BUNDA AUNI VILLA NUSA INDAH, BLOK D5, NO.19 BPK.MUKLAS KEUANGAN

021-

82402286/82420366/82403

873|

021-82410136 N Y Y ACTIVE ALL COVERAGE [email protected]

521 0147RS KARYA MEDIKA BANTAR

GEBANG(d/h KARYA MEDIKA IV)

JL. NAROGONG RAYA, KM.11, BANTAR

GEBANGBPK. ALLOSIUS

PELAYANAN

PASIEN021-8254629|021-8254630 021-8254629 Y Y Y ACTIVE ALL COVERAGE

522 0151KLINIK MULYA MEDIKA (APOTIK

MURNI)

JL. RAYA JATI MULYA, NO.1, BEKASI

TIMURBPK. RUNTUNG MARKETING 021-8203272| 021-8203272 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

523 0409 KLINIK DHARMA MEDIKA JL. PEMUDA, NO.33, KRANJI IBU BETTY KEUANGAN 021-8855173,8866711| 021-8866711 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

524 0185 RS. BHAKTI KARTINI JL. KARTINI, NO.11IBU HILDA/ BPK

FIRMANMARKETING 021-8801954/88348492| 021-8824228 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

525 0767 KLINIK MHT BEKASIJL. H.M JOYO MARTONO NO.31B

BEKASI TIMUR

DR FRISKA

GULTOM/IBU DJESKOORDINATOR 021-8814262| 021-8814262 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

526 0620 RS. KARYA MEDIKA II (D/H RSIA. )JL. SULTAN HASANUDIN NO.63

TAMBUNIBU. DEBBY / MERY MARKETING

021-883 24366;

70934766021-

88361980|021-88361980

021-88327514 Y Y Y ACTIVE ALL COVERAGEmarketing-

[email protected]

527 0766 RS. ANANDA BEKASIJL. SULTAN AGUNG NO.17, MEDAN

SATRIA BEKASIBPK JOKO/BRAM MARKETING 021-8854338| 021- 88950141 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

528 0410 RS. BELLA JL. IR. JUANDA, NO.141 IBU AMEL GRACE MARKETING

021-880 1775/

880177/8819377021-

880177|021- 880177

02188342438/883

52506Y Y Y ACTIVE ALL COVERAGE [email protected]

529 0384 RS. MEKAR SARI JL. MEKAR SARI, NO.1 DRG. AMI MARKETING021-8802641,8813787021-

8813787|021-8813787

021-

8810055/8835090

8

Y Y Y ACTIVE ALL COVERAGE [email protected]

530 0250 KLINIK KARYA MEDIKA I JL. IR H JUANDA NO.38 C BPK HERMAN KOORDINATOR021-8801293021-

8800381|021-8800381021-8816137 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

531 0188KLINIK FAJAR MEDIKA ( GROUP

KARYA MEDIKA )

RUKO KAWASAN INDUSTRI MM2100,

CIBITUNGIBU INA MARKETING 021-8981162| 021-8981162 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

532 0887 KLINIK MULYA MEDIKA IIJL. PERUMAHAN GRAMA PURI, BLOK

D1, NO.5, CIBITUNGBPK. HAKIM KOORDINATOR 021-8836248| 021-88362481 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

533 0715 KLINIK MUTIARA I (CITRA HUSADA I)PERUM METLAND JL. KALIMAYA 6 BLOK

L2 / 1 BEKASI

BPK. KEMAL / BPK.

RONNY/KEUANGAN 021-29487893| 021-88337919 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

534 0294KLINIK KARYA MEDIKA III (APOTIK

MEKAR ASRI)

JL. PERJUANGAN, NO.30C, TELUK

BUYUNGIBU EUIS KOORDINATOR 021-8851152| 021-8851152 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

535 0819 RB & KLINIK PERMATA BUNDA SETUPERUM GRAHA MUSTIKA MEDIA, BLOK

A5, NO.15, SETUIBU TIA ADM 82611729 / 88328001| 82611729 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

536 0847 RS. ANNAJL. PEKAYON RAYA NO.36, BEKASI

SELATANIBU MAMI MARKETING 021-82432211| 021-82419079 Y Y Y ACTIVE ALL COVERAGE [email protected]

537 0873 APOTIK & KLINIK LEGENDA SEHATJL. ZAMRUD UTARA BLOK U16 NO.100

KOTA LEGENDABPK.BUDI JULIANTO KOORDINATOR 021-82600148| 021-82606179 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

538 2539 MITRASANA PONDOK TIMUR

PONDOK TIMUR INDAH BLOK G NO 1

PONDOK TIMURKEL JATIMULYA KEC

TAMBUN SELATAN KAB BEKASI

- - 36822510 / 08891259024| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

539 2461KLINIK 24 JAM & RB. PERMATA

BUNDA CIBITUNG

JL. RAYA WANAJAYA - CIBITUNG,

BEKASIIBU ZENDRI - 021 - 88322064, 88323062| - N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

540 2545 MITRASANA TITIAN INDAH

JL. PERUM TITIAN INDAH BLOK I NO 9

RT 07 RW 10 KEL. KALIBARU KEC

MEDAN SATRIA KOTA BEKASI

- - 021-94178815| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

541 1816 RS. HARAPAN MULIAJL. RAYA CIBARUSAH NO. 5 KB. KOPI,

CIBARUSAH JAYA KAB. BEKASI

HENDRO L

PRASETYO / LINDAMARKETING 021-89952340| 021-89952460 Y Y Y ACTIVE ALL COVERAGE [email protected]

542 1830 RB & KLINIK AMIRA CIKARANGJL. RAYA BY PASS LEMAH ABANG,

CIKARANG TIMURDR. DEDY - 021-8914 2719| 021-89142719 N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

543 1937 APOTIK FARMARIN VII BEKASI

JL. GURAME RAYA PERTOKOAN KAV.29

PERUMNAS KAV.29 PERUMNAS II KEL,

KAYU RINGIN RAYA KEC BEKASI

SELATAN.

HIKMAH APRILIANI - 02188968419| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 20 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI544 1924 KLINIK MANDIRI

PERUM VILLA MUTIARA CIKARANG

BLOK R 26-27 CIKARANG SELATAN

IBU.IIN IRA

KARTIKAPEMILIK 021-897 4883| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

545 2057 KLINIK BATARA SATU MEDIKAJL. KH. NOER ALI NO. 10 KP. IRIAN RT.

03/04 TELUK PUCUNG, BEKASI UTARAASEP KUSTARA - 021-89133229| 021-82589090 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

546 2091 KLINIK SITI ZAHROHPERUMAHAN GRAND RESIDENT RR 100

SETU - BEKASIBPK ERI PEMILIK 021-8261.8362| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

547 2036 RB & KLINIK DR IQBAL TAUFAN

VILA MUTIARA CIKARANG 2 BLOK B1

NO. 27, DESA SUKASEJATI CIKARANG

SELATAN, BEKASI

IBU NANIK KOORDINATOR 021-89902361| 021-89902361 N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

548 1971 RB. WIJAYANTIJL. PERUM GRIYA BEKASI PERMAI BLOK

H6 NO 17, TELAJUNG-CIKARANG BARATIBU MOMO PEMILIK 021-29371856/97958619| 021-82602243 N Y Y ACTIVE ALL COVERAGE -

549 1951 KLINIK & APOTEK KF 387JL. JATIWARINGIN NO 5 PONDOK GEDE

BEKASISHINTA YULIZRA - 021-8461980| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

550 1965 KLINIK KU JL. DR. RATNA JATI ASIH BEKASIDR. SARI

RAHADJENG- 021-84901303| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

551 1584 KLINIK RIBU MEDIKAJL. RAWA JULANG DESA MEKARWANGI

KEC. CIKARANG BARAT, BEKASI

IBU ROSTARIA

BANGUNKOORDINATOR 021-91303916/89983577| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

552 0063 RS. MULTAZAM MEDIKAJL. PERUMAHAN JATIMULYA NO.1

TAMBUN SELATAN, BEKASI 17510IBU IRMA MARKETING

021-8215101/8215102021-

8215102|021-8215102021-82416678 Y Y Y ACTIVE ALL COVERAGE [email protected]

553 1553 RS. HERMINA GRAND WISATAJL. FESTIVAL BOULEVARD BLOK JA NO.

I, GRAND WISATA,BPK.SUNGKONO MARKETING 021-8265 1212| 021-825 2963 Y Y Y ACTIVE ALL COVERAGE

grandwisata@herminahospitalgr

oup.com

554 0016 RS. KARYA MEDIKA CIBITUNGJL. RAYA IMAM BONJOL, NO.9B,

CIKARANG BARAT, CIBITUNG

IBU

TITIN/FERYANA/IND

AH

MARKETING021-8900190-1 & 8903003-

4|021-89107753 Y Y Y ACTIVE ALL COVERAGE [email protected]

555 1588RB. ASYIFA HUSADA MEDICAL

CENTER

PERUM. BEKASI REGENCY I BLOK K I

NO. 1, CIBITUNGERWAN JAUHARY MARKETING 021-88333535| 021-88332152 Y Y Y ACTIVE ALL COVERAGE [email protected]

556 1595 KLINIK VNV MEDIESTETIKOMPLEK PEMDA BLOK C JATI ASIH

BEKASIBP SOFYAN Marketing 021-82435767| 021-82435767 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

557 1334 RS. ANNA MEDIKAJL. RAYA PERJUANGAN NO 45,

HARAPAN BARU, BEKASI UTARA

IBU ELA

KUSMIATI/BPK.

ALIM

MARKETING 021 - 88882211| 021 - 88973042 Y Y Y ACTIVE ALL COVERAGE [email protected]

558 1350 RS. MITRA KELUARGA CIBUBUR JL. ALTERNATIF TRANSYOGI, CIBUBUR IBU RINA MARKETING 021-84311771/84311777| 021-84311661 Y Y Y ACTIVE ALL [email protected]

m

559 1586 RSIA. SRITINA JL. IMAM BONJOL NO.80A BEKASI IBU INDAH MARKETING 021-8900579-89106317| 021-89106633 Y Y Y ACTIVE ALL COVERAGE [email protected]

560 1640 RS. JATI RAHAYUJL. RAYA HANKAM NO 17 PONDOK

MELATI BEKASIIBU SHINTA MARKETING

021-

8462566,8462565,8497257

8|

021-84992723 Y Y Y ACTIVE ALL [email protected];

[email protected]

561 1769 KLINIK SATELIT GSM BEKASIBEKASI SQUARE NO 65-66 JL. AHMAD

YANI PEKAYON JAYA BEKASI SELATANBPK AGUNG - 021-82425408| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

562 1771 RS. KARTIKA HUSADA SETUJL. BURANGKENG RT 01/06 DESA

BURANGKENG SETU BEKASI

IBU ANDRI

ICHSANTIMARKETING 021-82610003/4| 021- 82610005 Y Y Y ACTIVE ALL COVERAGE [email protected]

563 1807 RS. TIARA BEKASIJL. RAYA BABELAN NO. 63 KEL.

KEBALEN KEC. BABELAN KAB. BEKASIIBU LITA Marketing 021-89131111| 021-89132039 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

564 1486RS. AWAL BROS BEKASI (D/H RS.

GLOBAL AWAL BROS )

JL. KH.NOER ALI KAV.17-18

KALIMALANGBPK YADI/IBU MIMI MARKETING 021-8868888/88855333|

02188855222/888

55210Y Y Y ACTIVE ALL COVERAGE [email protected]

565 1261 RS. HOSANA MEDICA BEKASI JL. PRAMUKA NO.12 RAWA LUMBU BP YOSEP DIREKTUR 021-8221570/73|021-

8224604/8221574Y Y Y ACTIVE ALL COVERAGE

[email protected];hos

anamedicabekasi1@gmail

566 1417 RSIA. RINOVA INTAN JL. RAYA SEROJA NO.101 BPK.LUHUT KOORDINATOR 021-8849401| 021-8848739 Y Y Y ACTIVE ALL COVERAGE -

567 1203 KLINIK SEHAT SEJAHTERA IJL. RAYA NUSANTARA NO.2 PERUMNAS

III BEKASI TIMUR

IBU.JANAH/HAYATI

WIDIODOKoordinator 021-88349427| 88349427 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

568 1204 KLINIK SEHAT SEJAHTERA II PERUM REGENSI - BEKASI TIMURIBU.PUJI/HAYATI

WIDODOKoordinator 021-88367194| 88349427 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

569 1062 RS. CIBITUNG MEDIKAJL. RAYA H.BOSIH NO.117

DS.WANASARI,CIBITUNG-BEKASI

RUSTOMY FADILLAH

/ ENNIKE

MARYATININGRUM

Marketing 021-88323444/88393181-|-02188323449/883

72866Y Y Y ACTIVE ALL COVERAGE [email protected]

570 1989RSIA. KARUNIA KASIH (KARUNIA

BUNDA)

JL. RAYA JATI WARINGIN NO. 133

PONDOK GEDE KOTA BEKASIIBU GRACE Marketing 021-8461970| 021- 8460991 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

571 3367 KLINIK CENTRAL MEDIKA2

JL. KH. FUDHOLI (KEBON KPI) DESA

KARANG ASIH, KEC. CIKARANG UTARA

KAB. BEKASI

DR. LIA -- 021-89100879| 021-89100877 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

572 0178 RS. HERMINA BEKASI JL. KEMAKMURAN, NO.39, MARGAJAYADR.CHEYRA/IBU.CH

RISTINEMARKETING 021-8842121/30| 021- 88952275 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 21 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI573 3382 KHARISMA MEDICAL CENTER JL. CAMAN RAYA NO.54 BEKASI IBU TIARA MARKETING 021-84991671| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

marketing@kharismamedicalcent

er.co.id

574 2528 MITRASANA ALAMANDA REGENCY

"JL. KAMPUNG RAWA KALONG RT 01/

RW 03 KARANG SATRIA BLOK N 01 NO

43 TAMBUN UTARA, BEKASI

ELI NURHAYATI - 70874627/ 08891258883| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

575 2534 MITRASANA KRANJIJL. FAJAR NIAGA D1 NO 73 KEL JAKA

SAMPURNA KEC BEKASI BARATIBU DEVI koordinator 88951275| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

576 2613 KLINIK & APOTIK MAHADINA MEDIKA JL. KH. BOSIH NO.9 CIBITUNG EEN - -| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHARumar.bakrun.bakrun85@gmail

577 2508 MITRASANA TAMAN HARAPAN BARU

JL. TAMAN HARAPAN BARU BLOK E7

NO 9, PEJUANG, MEDAN SATRIA,

BEKASI BARAT

- - 88870793 / 08891259038| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

578 2802 KLINIK PERTAMEDIKA BEKASI

RUKO KALIMALANG SQUARE BLOK J

NO. 17, JL. KALIMALANG RAYA -

BEKASI BARAT

HENDRI

(081806762901)- 021-88962946| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

579 2803KLINIK PERTAMEDIKA JATIWARINGIN

ASRI

JL. SANGATTA NO. 1 JATIWARINGIN

PONDOK GEDE 17411

SRI ENDRA

(081317520046)- 021-84990644| 021-84970944 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

580 2402KLINIK & RB CAHAYA MEDIKA (Group

HARAPAN SEHAT CI)

Jl. Rawa Julang RT. 02/01, Desa Ganda

Mekar Kec. Cikrang Barat ¿ BekasiDR. ERNA - (021) 8998 4009| - N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

-

581 2689 KLINIK & APOTEK KF 367 JL. JATIMEKAR NO. 33 JATIASIHNUR FADILLAH,S

FARM., APT.021 8473403| N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

582 0161 RS. MITRA KELUARGA BEKASI TIMURJL. PENGASINAN RAWA SEMUT

MARGAHAYU, BEKASI TIMURIBU LINDA/ HARTI MARKETING 021-8817777/89999222|

8820707/8999928

6Y Y Y ACTIVE ALL COVERAGE

[email protected]

om

583 0891 RS. HERMINA GALAXYJL. GARDENIA RAYA SELATAN BLOK

BA1 NO.11BPK.DEFNI MANSUR MARKETING 021-8222525/82417777| 021-82414087 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

584 2433 KLINIK TAMAN FIRDAUS MEDIKAPERUM TAMAN FIRDAUS RESIDENCE

BLOK A 06 NO.17 CIBARUSA BEKASIBPK ERIK/ BP RICO - 021 - 89950047| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

585 2611 KLINIK AMELIA

VILA MUTIARA GADING 2 KOMPLEK

RUKO ROXY BLOK DD.10 NO.1 KARANG

SATRIA BEKASI

DR. IDA ROHAYANI - -| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

586 2560 MITRASANA MOCHTAR TABRANI

JL. KH MUCHTAR TABRANI RT 003 RW

03 KEL. PERWIRA KEC. BEKASI UTARA

KOTA BEKASI

TIKA - 36822504/ 08891259008| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

587 2594MITRASANA BUMI CIKARANG

MAKMUR

BUMI CIKARANG MAKMUR BLOK F 10

NO. 6 KEL. SUKADAMI, KEC. CIKARANG

SELATAN, KAB. BEKASI

IBU RATMI Koordinator021-36164232/ 021-

34618046|- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

588 2512 MITRASANA KAMPUNG CEREWED

RUKO LIBERS. A GARDEN NO. 23 JL.

KARANG SATRIA(SEBELAH PERUM

KAMPUNG CEREWED), DUREN JAYA

BEKASI TIMUR

- - 88343753| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

589 2514 MITRASANA PESONA KHAYANGAN

RUKO PESONA KHAYANGAN BLOK B

NO.6 , JL. M. YUSUF, KEL. MEKARJAYA,

KEC. SUKMAJAYA

IBU ELVANA (STORE

MANAGER)- 77822980| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

590 2515 MITRASANA KALIABANG

"RUKO FITRA JAYA, JL. KALIABANG RT

01/06 NO. 7 KEL PERWIRA KEC BEKASI

UTARA

INA MASTUHA - 021-88974206| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

591 2518MITRASANA MUTIARA GADING

TIMUR

RUKO MUTIARA GADING TIMUR 2 BLOK

R 02-23 KELURAHAN MUSTIKA JAYA

KECAMATAN BANTAR GEBANG BEKASI

NURHASANAH - 085100771573| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

592 2520 MITRASANA UJUNG HARAPAN

"KAMPUNG UJUNG HARAPAN RT 02/ RW

15 KEL. BAHAGIA KEC. BABELAN KAB.

BEKASI

IVANA - 021-29258727/ 70874627| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

593 2521 MITRASANA BUMI SANI PERMAI

"JL. BUMI SANI PERMAI RT 02 RW 011

KAMPUNG BULU KEL SETUIA MEKAR

KEC TAMBUN SELATAN BEKASI

TINI - 71347468| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

594 2523 MITRASANA HARAPAN BARU 2"PERUM HARAPAN BARU II D8-02 RT 03

RW 02 KOTA BARU BEKASI BARATAFAL MASANI - 88950943| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

595 2525 MITRASANA SAKURA REGENCY

"JL. WIBAWA MUKTI 2 KOMP. SAKURA

REGENCY BLOK KM 8 ¿ 12 JATIASIH

BEKASI

MIRA - 021-82441692| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

596 2527 MITRASANA KOTA SERANG BARU

"JL. PERUM KOTA SERANG BARU BLOK

A/47 NO 5 KEL SUKARAGAM, KEC

SERANG BARU KAB BEKASI

- - 36502354| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 22 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI597 2531 MITRASANA GRAND WISATA

RUKO CELEBRATION BOULEVARD BLOK

AA9 NO.12 PERUMAHAN GRAND

WISATA KEL. LAMBANG SARI KEC.

TAMBUN BEKASI

- - 71209133 / 08891258904| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

598 2533 MITRASANA PEKAYON JAYA

RUKO PENINSULA JL. PULO RIBUNG RT

01 NO. 1D KEL. PEKAYON JAYA KEC.

BEKASI SELATAN BEKASI SELATAN

RANI - 82429641| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

599 2535MITRASANA PEJUANG HARAPAN

BARU

JL. PEJUANG 04 BLOK B/ 234 RT 13 RW

11 PEJUANG MEDAN SATRIASUSI - 021-70813640| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

600 2509 MITRASANA PONDOK UNGU PERMAI

PONDOK UNGU PERMAI AC 1 NO 20A &

20B RT 003 RW 009, BAHAGIA,

BABELAN - BEKASI

INDRI RAHMAWATI - 021-88882300| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

601 2511 MITRASANA DUKUH ZAMRUDJL. ZAMRUD UTARA RUKO BLOK S.1

NO. 18 KOTA LEGENDA,BEKASI TIMUR- - 08891258897/ 82602911| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

602 2513 MITRASANA MEGA REGENCY 2

"JL. PERUM MEGA REGENCY BLOK D3

NO 5 KEL SUKARAGAM KEC SERANG

BARU KAB BEKASI

- - 36771573/ 08891259006| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

603 0735 RS. KARTIKA HUSADA TAMBUN

JL. MANGUN JAYA RAYA KP.RUKEM

RT.003/013, DESA MANGUN JAYA,

TAMBUN - BEKASI

SRI

WARDININGSIH/FIT

RI/ANJAR

MARKETING

021-88338346,

88327281021-9172736|021-

9172736

021-88322529 Y Y Y ACTIVE ALL COVERAGE [email protected]

604 0843 KLINIK DHARMA BHAKTI

JL. RAYA BOSIH BLOK A4 NO.23

PONDOK TANAH MAS, CIBITUNG -

BEKASI

BPK SUDIARTO HUMAS 021-8831441-|-021-

8831441/8830246N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

605 1558 KLINIK ASYIFA HUSADAPERUM. VILLA MUTIARA JAYA BLOK N.

78 /11-12, WANAJAYA, CIBITUNGERWAN JAUHARY KOORDINATOR 021-88338235| 021-88338235 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected] /

[email protected]

BOGOR

606 3000 RSUD. KOTA BOGORJL. DR. SUMERU NO. 120 MENTENG,

BOGOR BARAT 16111

IBU RINA/BPK YANI/

MIA- 0251-8312292| 0251-8371001 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

607 2517 MITRASANA VILLA NUSA INDAH

PERUM VILLA NUSA INDAH BLOK F2

NO. 15 DESA BOJONG KULUR KEC.

GUNUNG PUTRI KAB. BOGOR

- - 82429508| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

608 2955 RS. PERMATA JONGGOL

JL. RAYA JONGGOL NO.1 A RT.008

RW.03, SUKAMANAH, JONGGOL,

BOGOR

IBU ARUM MARKETING 021-8993 1222| 021- 8993 1836 Y Y Y ACTIVE ALL [email protected];

[email protected]

609 3990 RSIA. BUNDA SURYATNI

JL. KH. SOLEH ISKANDAR NO. 21,

CIBADAK, TANAH SAREAL, BOGOR

16161

Nuna Nur Mina MARKETING (0251) 754 3892| (0251) 754 3892 Y Y Y ACTIVE ALL COVERAGE [email protected]

610 2393 RSIA. UMMIJL. EMPANG II NO.2 BOGOR RT.004/002

BOGOR SELATANBAPAK DEDE MARKETING 0251-8341600| 0251-8341606 Y Y Y ACTIVE ALL COVERAGE [email protected]

611 3420 RS. MULIA PAJAJARAN JL. RAYA PAJAJARAN NO. 98, BOGORIBU EFI/ DR

RADIANTIDIREKTUR 0251-8379898| 0251-8378800 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

612 2979 LAB. KLINIK KIMIA FARMA BOGOR JL. IR. H. JUANDA NO. 30, BOGOR IBU YUNI KOORDINATOR 0251 - 8319030| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

613 3330 LAB. KIMIA FARMA 50 JL. MERDEKA NO. 24 BOGOR IBU UMI - 0251-271708| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

614 1235 KLINIK & APOTEK KF 7 BOGOR JL. IR. H JUANDA NO. 30 TUTI EKAWATI -0251-8363473 / 8319030

(Lab)|N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

615 2772 KLINIK SHIFA MEDIKAJL. BRANTA MULIA RT.002/07 KARANG

ASEM TIMUR, CITEUREUP - BOGOR

DR. RIANA

ROCHMAWATI

(081319980958)

- (021) 8760357| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

616 2759 RS. KARYA BHAKTI PRATIWIJL. RAYA DRAMAGA KM. 7, DRAMAGA,

BOGORBP NURWANDY MARKETING (0251) 8626868| (0251) 8626969 Y Y Y ACTIVE ALL COVERAGE

[email protected]

o.id

617 2718 KLINIK PELITA SEHAT CIOMASJL. RAYA TAMAN PAGELARAN BLOK C1

NO.5, PADASUKA, CIOMAS, BOGOR

DR. JUNAIDY

(08129922058)OWNER (0251) 7522167| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

618 2788 RSIA. ASSALAMJL. RAYA BOGOR KM 46, NANGGEWER

MEKAR, CIBINONG, BOGORIBU KHOLIS - (021) 8753724| - Y Y Y ACTIVE ALL COVERAGE [email protected]

619 2703 KIMIA FARMA 362 JL. MAYOR OKING 112 C, CIBINONG

ROSA TADIANTI

PUTRI, S.FARM.,

APT

- 021 87914400| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

620 0992 RS. BOGOR MEDICAL CENTER JL. PAJAJARAN INDAH V/97 BOGORDRH.SITTI NUR

ARAFAH, IBU LISNAMARKETING

0251-

8307900/8390435/8346002

/83797430251-

346002|0251-346002

0251-

8313987/8353419Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

621 2809 KLINIK PERTAMEDIKA BOGORJL. PANDAWA BLOK A-1 NO 14-15

BANTAR JATI II BUMI INDAH PRASTA IIIN (081386613335) - 0251-8363994| 0251-8363993 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

622 3709 RS. VANIAJL. SILIWANGI NO.11 SUKASARI

BOGOR TIMURSKOLASTIKA SENDY MARKETING 0251-8380601/8380605| 0251-8380612 Y Y Y ACTIVE ALL COVERAGE [email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 23 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI623 2172 KLINIK BHAKTI RAHAYU LEUWILIANG

JL. RAYA GALUGA NO. 120

CIBUNGBULANG, BOGORBPK YUYU RAHAYU - 0251-8648201| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

624 2191 RS. MEDIKA DRAMAGAJL. RAYA DRAMAGA KM. 7.3

MARGAJAYA BOGORBP. YOGI MARKETING

0251- 8308900;

081319310610|0251- 862577 Y Y Y ACTIVE ALL COVERAGE [email protected]

625 2441 KLINIK NADYA MH THAMRIN

JL. KH ABDULLAH BIN NUH RT. 005/

RW. 01 KEL. SINDANG BARNAG, KEC.

BOGOR BARAT

DR. WENI

PUSPASARI- (0251) 8624629| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

626 2388 RS. PERTAMEDIKA SENTUL CITYJL. MH THAMRIN KAV 57 SENTUL CITY -

BOGOR 16810

dr. Bertie

riyestavaniMARKETING 021-29672990/29672977| - Y Y Y ACTIVE ALL COVERAGE

bertie.riyestavani@pertamedikas

entul.co.id

627 2456 RSIA. JULIANA JL. RAYA TAJUR NO 75A - BOGORIBU FITRI/ BPK

SURYAKERTAMarketing 0251 - 8339593| 0251-8339591 Y Y Y ACTIVE ALL COVERAGE [email protected]

628 2624 IZI CLINIC JL. ACHMAD ADNAWIJAYA NO.115YUZHI FADILAH

ARS. Y, S.FARMClinic Manager (0251) 8356621| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

willy-

[email protected]

629 0468 RS. PMI BOGOR JL. RAYA PAJAJARAN, NO.80 IBU CITRA/ YUDHA MARKETING 0251-8324080-|-0251-

8382936/8324709Y Y Y ACTIVE ALL COVERAGE

[email protected]/rspmi_k

[email protected]

630 1831 KLINIK PELITA SEHAT CIBINONGJL. MAYOR OKING NO 510 (SAMPING

SEKOLAH MARDI WALUYA)IBU YASIKA/ RIRIN MARKETING 021-70230178| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

631 1832 KLINIK PELITA SEHAT BANGBARUNGJL. ACHMAD SOBANA/ BANGBARUNG

77 BOGOR- - 0251-8362525| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

632 1833KLINIK PELITA SEHAT TAMAN

KENARI

RUKO PERUMAHAN TAMAN KENARI

BLOK E3 NO 4, TANAH BARU BOGOR- - 0251-8664767| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

633 1823 KLINIK SALSABILA MEDICAL CENTRE

JL. KSR DADI KUSMAYADI RUKO

LAMPU MERAH CIKARET NO. 70

CIBINONG-BOGOR

IBU SHELLY - 021-87905768| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

634 1913 KLINIK PURI MEDIKAJL. RAYA CIKARET NO. 12 CIBINONG,

BOGOR- -- 021-87903120| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

635 2116 RS. HERMINA MEKARSARIJL. RAYA CILEUNGSI - JONGGOL KM 1

KABUPATEN BOGOR 16820

DRG. EROS SYAH

WORONGAN, MARS.- 021-29232525| 021-2923770 Y Y Y ACTIVE ALL COVERAGE

mekarsari@herminahospitalgrou

p.com

636 0720 RSIA. CITRA INSANI

JL. RAYA PARUNG NO.242,

LEBAKWANGI PEMAGARS. ARI, PARUNG

BOGOR

DR. FERDINAND Y H

SMARKETING

0251 -

8611507/86177270251-

611507|0251-611507

0251 - 8617493 Y Y Y ACTIVE ALL [email protected]

.id

637 1952 KLINIK & APOTEK KF 50 JL. MERDEKA NO 24 BOGORDRS. HENDI

WIJAYA, APT- 0251-8384247 / 8321525| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

638 1385 RS. SENTRA MEDIKA CIBINONGJL. MAYOR OKING JAYA ATMAJA NO.9

CIBINONG

IBU DEVI IBU DEA /

IBU TRI ANA

DARMAWANTI

MARKETING 021-87909999/87911212| 021-87909377 Y Y Y ACTIVE ALL [email protected]

om

639 0755 RS. BINA HUSADA CIBINONGJL. MAYOR O KING NO.101, CIBINONG -

BOGORDR.YUNI MARKETING

021-8758441; 87911000021-

8753422-|021- 8753422-021-8752463 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m;[email protected]

640 1583 KLINIK TLAJUNGJL. MERCEDES BENZ NO. 79 GUNUNG

PUTRI BOGORDR. SUMARNI - 021-8675604| 021-8675604 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

641 1679 RSIA. ANNISA CITEUREUPJL. KARANGGAN NO 02 PUSPASARI

CITEUREUP - BOGOR

DR. DENI/BPK

HENDRYMARKETING 021-8756780; 8752628| 021-8752628 Y Y Y ACTIVE ALL COVERAGE [email protected];

642 1680 RSIA. SENTOSA JL. RAYA KEMANG NO 18 BOGOR BPK JAYNUDIN MARKETING 0251-7541900| 0251-7541900 Y Y Y ACTIVE ALL [email protected]/biancak

[email protected]

643 1673 RB. PELITA SEHAT POMADJL. RAYA CIBULUH RUKO NO 9

SIMPANG POMAD KEC BOGOR UTARAIBU LINA Marketing

0251-8652628; 0251-

8658811|0251-8658811 Y Y Y ACTIVE ALL COVERAGE [email protected]

644 1662 RSIA. KENARI GRAHA MEDIKAGRIYA KENARI MAS BLOK B2

CILEUNGSIIBU KINING MARKETING

021-

8230426/82499885/966840

76|

021-8231829 Y Y Y ACTIVE ALL COVERAGE [email protected]

645 1419RB & KLINIK CITAMA KEDUNG

WARINGIN GRAVERIJL. BOJONG GEDE-BOGOR IBU DARNI / MANDA KOORDINATOR 021-87983434| Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

646 1297 RB & KLINIK INSANI JL. PAHLAWAN NO.73B CITEUREUP IBU SRI KEUANGAN 021.70247742/ 87942723| 021-87942570 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

647 1353 RS. CITAMAJL. RAYA PABUARAN NO. 52

BOJONGGEDE-BOGOR

IBU MANDA / IBU

TRIMARKETING 021-87985555| 021-87986666 Y Y Y ACTIVE ALL COVERAGE [email protected]

648 1533 KLINIK DR.BETTYJL. RAYA NAROGONG, PERUMAHAN

PT.SEMEN CIBINONG, CILEUNGSIIBU HANNA/Shinta KOORDINATOR 021-82493032| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

649 1484 RB & KLINIK TRIMITRAJL. RAYA GUNUNG PUTRI KM 117,

GUNUNG PUTRIIBU EVA MARKETING 021-8672005| - Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

-

650 0133 RSIA. HERMINA BOGORJL. RING ROAD-1, KAV.23,25,27,

PERUM. TMN. YASMIN

DRG. RETNO/ IBU.

ROLLIMARKETING 0251-8382525| 0251-8328252 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 24 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI651 0932 KLINIK MHT CIPAYUNG JL. RAYA PUNCAK CIPAYUNG

BPK NUGRAHA/ BPK

ANDREADM/ marketing 0251-8256172-|- 0251-8257648 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

652 1103 RS. TRIMITRA CIBINONG JL. RAYA CIBINONG KM.43IBU WIDI/

BPK.MASOEDMARKETING

021-8763055-56021-

8765993|021-8765993021-8758038 Y Y Y ACTIVE ALL COVERAGE [email protected]

653 1134 RB. KLINIK HARAPAN IBUJL. RAYA CIKABON NO.108 PARUNG

PANJANG

IBU UBUN NINGSIH

/ LIAPIMPINAN

021-54260635 /

089664392582/0896421489

75|

021-54260635 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

654 1251 KLINIK INSANI CIBINONGJL. MAYOR OKING, NO.58A, CIRIUNG,

CIBINONGIBU SRI KEUANGAN 021-8757567| 021-8757567 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

655 0290 RS. MARY CILEUNGSI HIJAUJL. RAYA NAROGONG, KM.21,

CILEUNGSI

BAPAK ARIF/TEGUH

WARDOYOMARKETING 021-82492222| 021-82493902 Y Y Y ACTIVE ALL COVERAGE [email protected]

656 0411 RS. AZRA JL. RAYA PAJAJARAN, NO.219RUSLI / PUTRI

MAKARTIMARKETING 0251-8318456-|-

0251-

8331773/8324093Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

657 0706 POLIKLINIK CIBULUH JL. KEDUNG HALANG TALANG, NO.148 IBU IYAN ROHYANI MARKETING 0251-8661947| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

658 0389 RS. MH THAMRIN CILEUNGSIJL. RAYA NAROGONG, KM.16, LIMUS

NUNGGAL, CILEUNGSI

BPK JANI / IBU

RATNAMARKETING

021-8235052 /

82491332021-

82491332|021-82491332

021-82491331 Y Y Y ACTIVE ALL COVERAGE [email protected];

659 0190 RS. ISLAM BOGORJL. PERDANA RAYA NO.22, BUDI

AGUNG - KEDUNG BADAK

IBU. GINA /

IBU.DIAHMARKETING 0251 - 8316822, 834713| 0251 -8347139 Y Y Y ACTIVE ALL COVERAGE

[email protected];rsislambog

[email protected]

660 0835RS. FAMILY MEDICAL CENTRE

BOGOR

JL. RAYA BOGOR KM.51 CIMANDALA-

SUKARAJADEBORA

HUMAS dan

MARKETING(0251) 8652391| 0251-8661 605 Y Y Y ACTIVE ALL COVERAGE

[email protected];debora0110@y

ahoo.com,

CIAMIS

661 1104 RS. PERMATA BUNDA CIAMIS JL. MR.IWA KUSUMASOMANTRI NO.1IBU HJ NANI

WARNIDAHMARKETING

0265-771650/7767450711-

356173|0711-3561730265-777658 Y Y Y ACTIVE ALL COVERAGE [email protected]

CIANJUR

662 2123 KLINIK PADJADJARAN SUKANAGARAJL. RAYA SUKANEGARA KM.45

SUKANEGARA - CIANJURIBU RIRIN KOORDINATOR

0263-340189/

085794056664|- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

663 2121 KLINIK ASSALAM CIKALONGJL. RAYA CIKALONG KULON NO. 61 A

KAB. CIANJURBPK RAGA KOORDINATOR

0263-318222 /

081290995603|- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

664 4107 RS. DR.HAFIZJL. PRAMUKA NO. 15 SUKAMULYA,

KARANG TENGAH, CIANJUR

IBU LESSY YANI

RUSLAN- 0263-2910000| (0263) 2910010 Y Y Y ACTIVE ALL COVERAGE [email protected]

CIKAMPEK

665 1409 RSU. PURI ASIH JATISARIJL. RAYA JATISARI NO.3 PASAR

JATISARIIBU ELLA MARKETING 0264-361459/361466| 0264-8375276 Y Y Y ACTIVE ALL COVERAGE [email protected]

666 1239RUMAH SAKIT IZZA D/H (RSU. AQMA

CIKAMPEK)

JL. KP.CISELAN DS.CIKAMPEK

UTARA.KARAWANG

BPK. ANDRI /BPK.

ALIKOORDINATOR 0264-319307/8386830-32| 0264-8386829 Y Y Y ACTIVE ALL COVERAGE [email protected]

667 2445 RS. TITIAN BUNDA JL. IR. H. JUANDA NO.123 CIKAMPEK RIZAL S. NASUTION Marketing (0264) 8385999/8386222| (0261) 8388936 Y Y Y ACTIVE ALL [email protected];

[email protected]

668 2472 RB & KLINIK NAURAH MEDIKAJL. A. YANI NO.02 RT.03 RW. 06 DS.

CIKAMPEK SELATAN, CIKAMPEKIBU YUNI - (0264) 8389999| - N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

669 1749 NAGASARI JL. JEND A. YANI NO 177 CIKAMPEK IBU IIS - 0264-316203| 0264-316203 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

670 1172KLINIK PUTRA MEDIKA ( GROUP

AQMA PUSAT )

JL. IR. H. JUANDA NO.14-19

SUKASEURI

BPK AGUS /

DHENI/DR.HJ

ISWADI

KOORDINATOR 0264-301652 / 8387129| 0264-8387129 N Y Y ACTIVE ALL COVERAGE [email protected]

671 0375 RS. KARYA HUSADAJL. JEND. A.YANI, NO.98, CIKAMPEK-

KARAWANGIBU YUYUN/FITRI MARKETING 0264-316188-89|

0264-

312834/301626Y Y Y ACTIVE ALL COVERAGE [email protected]

672 0540 RS. SARASWATIJL. JEND. A.YANI, NO.92, DAWUAN,

CIKAMPEK-KARAWANGIBU. AGNES/ANI MARKETING

0264-311531/316101/

311514/ 3115270264-

316391|0264-316391

0264-311531 Y Y Y ACTIVE ALL COVERAGE [email protected]

673 1497 KLINIK SEHATJL. PAWARENGAN NO. 37, DESA

DAWUAN TIMURBPK.FAUZI MARKETING 0264-8385103| 0264-8385103 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

m

674 1302 KLINIK PURI ASIH CIKAMPEK JL. STASIUN NO.2 CIKAMPEK KOTA IBU ELLA KOORDINATOR 0264-303558| 0264-303558 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

675 1300 KLINIK ANDINA CIKAMPEK JL. IR.H.JUANDA NO.17 DR.PUR ANA AISTU KOORDINATOR 0264-303759| 0264-8387680 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

676 0908 KLINIK KELUARGA GRAHA MEDIS JL. ACHMAD YANI NO. 51BPK.

CIPTO/DR.DIAHKOORDINATOR 0264-310101| 0264-310101 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

677 0093 KLINIK AQMA CIKAMPEK JL. STASIUN, NO.93 BPK.AGUS MARKETING 0264 - 310 524| 0264 - 319307 N Y Y ACTIVE ALL COVERAGE [email protected]

CIKARANG

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 25 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI678 0738 RS. AMANDA CIKARANG SELATAN

JL. RAYA SERANG NO.38 CIKARANG

SELATAN

DR.SULASTRI / IBU.

DIANMARKETING

021-8971643021-

89110011|021-89110011021-8970808 Y Y Y ACTIVE ALL COVERAGE

[email protected]/dr_la

[email protected]

679 0660RS. PERMATA KELUARGA LIPPO

CIKARANG d/h RS Harapan

JL. MH.THAMRIN,KAV.129, LIPPO

CIKARANGWulan / Ryan MARKETING 021-8990 5588/ 8990 1927|

02189901860/899

01902Y Y Y ACTIVE ALL COVERAGE [email protected]

680 0845 RS. SETIAJL. RAYA SERANG - CIBARUSAH NO.41

BEKASIBPK.DEDEN

kerjasama

asuransi021-8971240/70207424-|- 021-8975249 Y Y Y ACTIVE ALL COVERAGE [email protected]

681 1567 RB & KLINIK PUTRA MEDIKA

JL. N. PERUM VILA MUTIARA, KAMPUNG

KUKUN CIKARANG NO.115 RT.012/06

DS.CIANTAR

DR MULYANA DIREKTUR021-89677215;

02189677628|021-89677216 N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

682 1287RB & KLINIK NIZA ASYIFA BERSAMA

1

PERUMAHAN TELAGA HARAPAN BLOK

E1 NO.1 CIKARANG BARATIBU ENDANG ADM 021-89109638| 021-89109638 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

683 1308 RS. RIDHOKA SALMA JL. IMAM BONJOL NO.7 GARDU SAWAH IBU ENDAH KEMALA MARKETING 021-89116527| 021-89116528 Y Y Y ACTIVE ALL COVERAGEhumasmarketingridhokasalma@

ymail.com

684 1494 RB & KLINIK ANNISA IVJL. RAYA CIBARUSAH NO.63 SERANG

BARUIBU INDRI ADMINISTRASI 021-89954434| 021-89954434 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

-

685 1523 RSIA. NURUL ANNISA

JL. RAYA CIKARANG CIBARUSA NO 88

DS. SUKARESMI CIKARANG SELATAN,

BEKASI

IBU.NOVI MARKETING 021-897 4854/55| 021 - 8971122 Y Y Y ACTIVE ALL COVERAGE [email protected]

686 1462 RS. MITRA KELUARGA CIKARANG JL. INDUSTRI RAYA, LEMAH ABANGDR. WIDYA RETNO

W/ IBU MARIAMARKETING 021-89840500/89840900| 021-89845489 Y Y Y ACTIVE ALL COVERAGE

[email protected]

om

687 0306 RS. ANNISA CIKARANGJL. CIKARANG BARU, NO.31,

LEMAHABANG, CIKARANG UTARAdr. resti MARKETING

021-

8904165/8901962/8904503

021 - 8904503|021 -

8904503

021-

8903350/8911382

7

Y Y Y ACTIVE ALL COVERAGEmarketing@rsannisa-

cikarang.com

688 0385 RS. BHAKTI HUSADA JL. RE. MARTADINATA IBU ADITYA MARKETING021-8900530/1021-890

0531|021-890 0531021-8900570 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

689 1034 KLINIK HARAPAN SEHAT II

RUKO TELAGA HARAPAN BLOK F NO.16,

PERUMAHAN TELAGA HARAPAN,

CIKARANG BARAT

DR. ERNA MARKETING 021-8904519-|- - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

690 1041RS HARAPAN KELUARGA (d/h

RS.HARAPAN INTERNASIONAL)

JL.KASUARI RAYA KAV.1A-1B, KOTA

JABABEKA, CIKARANG BARUbpk Ervan MARKETING 021-89840745|- 021-89835839 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected];

691 0850KLINIK BERKAT MELIMPAH JABABEKA

(HOSANA MEDIKA II)

JL. KAWASAN INDUSTRI I, JABABEKA

B8, CIKARANG UTARA

DRG.SHINTA/DR

ISKANDAR

PELAYANAN

PASIEN

021-8937941021-

8937942|021-8937942

021-

8937942,8983305

5

N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

692 1050 RSIA. AMANDA CIKARANG UTARAJL. RAYA INDUSTRI NO.36,CIKARANG

UTARADR. SULASTRI MARKETING

021- 8900277 /

89110011021-8900277|021-

8900277

021-89110011 Y Y Y ACTIVE ALL COVERAGE [email protected]

693 0913 RS. ASRI MEDIKAJL. CITANDUY RAYA BLOK L II NO.1

CIKARANG UTARAIBU WULAN MARKETING 021-89142968, 89142969-|-

02189143860/891

43036Y Y Y ACTIVE ALL COVERAGE

[email protected]/rsia

[email protected]

694 0929 KLINIK RENNICHA PUTRAJL. RAYA CIKARANG CIBARUSAH NO 89

LIPPO CIKARANGBPK TARMUDJI MARKETING

021-8971852021-

8971658|021-8971658021-8971852 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

695 0960 RSB. MEKAR MULIAJL. KASUARI IV, SEKTOR MEKAR

ALAM,PASIMAL - CIKARANG BARUDR YENNI KOORDINATOR 021-8936940/66-|- 021-89830523 Y Y Y ACTIVE ALL COVERAGE

rsb.mekarmuliacikarang@yahoo.

com

696 0966 RB & KLINIK CENTRAL MEDIKAJL. PILAR - SUKATANI, DS SUKARAYA

NO 84, KARANG BAHAGIATEJA, ISKANDAR MARKETING 021- 89111103-|- 021-89119714 N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

697 0967 CITRA ARDHITA MEDIFARMACAPITOL BUSINESS PARK, BLOK B2, JL.

NIAGA RAYAIBU LISTI/ SUTOMO

MARKETING/

Direktur

021-89831945/7004236021-

89831946|021-89831946

02189831946/898

33385N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

698 1119 KLINIK SAPTA MITRA CIKARANGJL. RAYA CIKARANG - CIBARUSAH,

NO.39A, SUKARESMIBPK.ROBY CLINIC MANAGER 021-8975369| 021-8975369 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

699 1218 KLINIK CIKARANG MEDIKA JAYA JL. YOS SUDARS. O NO.27 CIKARANG BPK.WIJAYA / NOVI Pemilik/ Marketing 021-8900129| 021-8901318 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

700 0263 RB & KLINIK YAYASAN BINA MEDIKA KP. KONGSI, CIKARANG IBU SULASTRIPELAYANAN

PASIEN

021-8900050021-

8900051|021-8900051021-8900051 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

701 0391SILOAM HOSPITALS LIPPO

CIKARANG

JL. MH. THAMRIN, KAV.105, LIPPO

CIKARANG

DR.SISKA/IBU

RESTI/VICKY PMARKETING 021- 29636900|

021-

89900022/897247

0

Y Y Y ACTIVE ALL COVERAGE [email protected]

702 0406 KLINIK ANNISA II (CIKARANG) JL. CIBARUSAH RUKO POIN, NO.31 R BPK DADANGPELAYANAN

PASIEN021-8976189| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

703 2454RS. HOSANA MEDIKA CIKARANG

BARU

JL. ANGGREK I B2/2 RT.01/11 DS.

MEKARMUKTI - CIKARANGIBU ERNA MARKETING (021) 89835223| 021-89830442 Y Y Y ACTIVE ALL COVERAGE [email protected]

704 2510 MITRASANA TAMAN ASTERRUKO TAMAN ASTER KAV. A3 NO. 41

TELAGA ASIH CIKARANG BARAT- - 88333364| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

705 2462KLINIK 24 JAM & RB. PERMATA

BUNDA CIKARANG

RUKO GRAMA NIAGA H2 NO. 15/15A,

KARANG ASIH - CIKARANG UTARAIBU ZENDRI -

021 - 2928 2165, 021 -

2928 2166|- N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 26 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI706 2464 MITRASANA PT

RUKO PLAZA ROXY BLOK C NO. 8 JL.

KASUARI RAYA, KOTA HIJAU JABABEKA,

CIKARANG BARU

IBU ENDAH - 021-89835394| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

707 1824 KLINIK BUNDA AULIAJL. HAJI RATIM NO. 143 DS JATIWANGI

CIKARANG BARAT - BEKASIBP. RAMA/ YOLANDA Marketing

021-8998 3742 / 2897

3209|021-8998 3742 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

708 0275 RS. SENTRA MEDIKA CIKARANGJL. RAYA INDUSTRI PASIR GOMBONG

JABABEKA, CIKARANGIBU HENI MARKETING

021 8904160-64 / EXT

225/081297102702|

021-

8904159,8911111

2

Y Y Y ACTIVE ALL COVERAGE [email protected]

709 2061 RS. BUDI ASIH CIKARANG

JL. RAYA SERANG - CIBARUSAH RT 01/

RW 01 SERANG KEC.CIKARANG

SELATAN,BEKASI

BPK. CITRA Marketing 021 - 896 777 95| - Y Y Y ACTIVE ALL COVERAGE [email protected]

710 2087 KLINIK JB MEDICAL CENTERSHOP HOUSE PERMATA JUNCTION

BLOK B A-15 JABABEKA 1 CIKARANGICUK SUGIARTO MARKETING 021-89846023/24| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

711 2034 RSIA. CIKARANG MEDIKAJL. KH. FUHDOLI NO.78 KAMPUNG

KAUM CIKARANG UTARA, BEKASIBPK WAWAN - 021-8902210| 021-82607637 Y Y Y ACTIVE ALL COVERAGE [email protected]

712 1962 KLINIK & APOTEK KEMALAJL. TARUM BARAT 2, RUKO GRAND

ARTHA NIAGA 2 BLOK O2 NO. 23 - 23ADENI ABDURAHMAN Marketing 021-29083377 - 29083376| 021- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

713 0574 RB & KLINIK BUDI LUHUR

JL. RAYA IMAM BONJOL, NO.74,

RT.07/04, DESA

SUKADANAU,CIKARANG BARAT

BPK EKO KOORDINATOR 021- 88327226/88320116| 021-88327226 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected];

[email protected]

714 1719CMC CLINIC ( CIKARANG MEDICAL

CENTER )

SHOPHOUSE BLOK A NO 14-15, 28-29

JL. JABABEKA RAYA KAWASAN

INDUSTRI CIKARANG

IBU TIRA/BP BUDI MARKETING 021-8934371| 021-8934035 N Y Y ACTIVE ALL [email protected]/tirrad

[email protected]

715 1795 RB. KHANZA MEDIKAPERUM KOTA SERANG BARU BLOK B 72

NO 25-26, CIKARANGDARWIS - 021-91263025| 021-89953117 N Y Y ACTIVE ALL COVERAGE [email protected]

716 1842 RS. MEDIROSSA 2

JL. RAYA CIBARUSAH DESA

SINDANGMULYA KEC. CIBARUSAH

BEKASI

BPK OMAN Marketing 021-89955555| 021-89952355 Y Y Y ACTIVE ALL [email protected]

om

717 1415RB & KLINIK PERMATA BUNDA

FUDHOLI

JL. KH.FUDHOLY NO 11 KARANG ASIH,

CIKARANG UTARABPK.RUWIK - 021-8910080| - Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

718 1234RS. DR. SANDER B (D/H RS. HOSANA

MEDICA PILAR)

JL. K.H.DEWANTARA NO.33,DS KARANG

ASIH,CIKARANG UTARA

ODZIARMAN SE, IBU

UNTARI, BPK RIFKIHRD 021-89116176 / 77 / 78| 021-89116179 Y Y Y ACTIVE ALL COVERAGE [email protected]

719 1064KLINIK KASIH ANUGERAH SERANG

BARU (HOSANA MEDIKA C

JL. RAYA SERANG-CIBARUSAH

KP.BUNISARI RT.07/04 DS.SUKARAGAM

SERANG BARU

IBU YATRI/ DR.

THERESIAKOORDINATOR

021-

89952605,89952612021-

89952612|021-89952612

021-89951205 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

720 1067 RS. MEDIROSSAJL. INDUSTRI TEGAL GEDE - CIKARANG

SELATAN

BPK. KUJANG-IBU

DEWIMARKETING 021-89833216| 021-8934979 Y Y Y ACTIVE ALL COVERAGE [email protected]

721 1514 KLINIK SUMBER WARAS

JL. RAYA CIBARUSAH, KAMPUNG

CIJAMBE, SUKADAMI, CIKARANG

SELATAN

IBU NOVIANTI MANAGER KLINIK 021-8970524| 021-8970524 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

d

722 2505 MITRASANA MEGA REGENCY

RUKO KOTA MEGA REGENCY BLOK A 01

NO. 10, JL. RAYA CIKARANG -

CIBARUSAH KM 10

- - 70326665| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

723 2742 KLINIK SUMBER SEHATJL. KI FUDOLI RT.001/001 CIKARANG

UTARAIBU NOVI (021) 8900566, 68416442| (021) 8900566 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

d

724 0916 RB & KLINIK GRAHA BINA HUSADAJL. INDUSTRI SELATAN NO.1A, BLOK

NN 3A, INDUSTRI JABABEKA IIBAPAK BUDI Koordinator 021-89836243-|- 021-89836244 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

725 2496 KLINIK INSPIRA SABILA MAKMURRUKO MELAWAI BLOK A NO. 12 TLH

LIPPO CIKARAN

BPK ROCKY/ DR.

MASRULLOH- 085100990164| 2189903336 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

m

726 3992 KLINIK CENTRAL MEDIKA 3

JL. RAYA RENGAS BANDUNG NO.20

001/003,KARANG SAMBUNG,KEDUNG

WARINGIN,BEKASI

BP. RISKANDAR MARKETING 021-89142220| 021-89142221 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

727 2975 KLINIK PUTRA MEDIKA 3

JL. PERUM KOTA SERANG BARU, KP.

GEBANG DS. SUKARAGAM KEC.

SERANG BARU, BEKASI

DR. MULYANA

PANIJAOWNER (021) 89950333| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

728 2058 RSIA. GIZAR

JL. VILA MUTIARA CIKARANG, RUKO

PASADENA BLOK RA NO. 3, 5, 6

CIANTRA, CIKARANG SELATAN

TRIANA SINTAWATI,

SP- 021-89677240 / 89677204| 021-89677239 Y Y Y ACTIVE ALL COVERAGE [email protected]

729 0709 RS. HOSANA MEDICA LIPPOJL. UTAMA BIIE NO 01 LIPPO

CIKARANG

IBU DELIMA/IBU

DEWIMARKETING 021-8972472| 021-89900769 Y Y Y ACTIVE ALL COVERAGE [email protected]

CIMAHI

730 0268 RS. MITRA KASIH JL. RAYA CIBABAT NO.341, CIMAHI DR. RIZKI MARKETING022-

6654852,6652774,6654397|

022-

6654875/6642349Y Y Y ACTIVE ALL COVERAGE [email protected]

731 2221 RS. AVISENAJL. MELONGASIH NO. 170 CIJERAH -

CIMAHIBP HENDAR - 022 - 6000830| 022-6000830 Y Y Y ACTIVE ALL COVERAGE

[email protected]/Rsavisena@

gmail.com

732 2467 RSU. KASIH BUNDAJL. MAHAR MARTANEGARA NO.166

LEUWIGAJAH - CIMAHI 40521

IBU DWI

SUPRIATINIMARKETING 022- 6614221/ 6630585| 022- 6630583 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 27 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALICIREBON

733 2690 KIMIA FARMA 40 JL. PARUJAKAN NO.12 , CIREBON DRS. ALFIAN, APT. - 0231-208954| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

734 2378RS. KHUSUS JANTUNG HASNA

MEDIKA

JL. RD GILAP NO. 8 PALIMANAN TIMUR,

KABUPATEN CIREBONPAK UKON MARKETING 0231-343405; 343645| 0231-342224 Y Y Y ACTIVE ALL COVERAGE [email protected]

735 1029 RS. SUMBER WARAS CIWARINGINJL. URIP SUMOHARJO, NO.5,

CIWARINGINYUDITH MAROLITHA -

0231-

341079,3300888,341079-|-0231-342112 Y Y Y ACTIVE ALL COVERAGE [email protected]

736 3882 RSIA. CAHAYA BUNDAJL. RAYA PERJUANGAN NO.8 KESAMBI

CIREBONDADI YUDI HUMAS 0231-8333388 / 99| 0231-482121 Y Y Y ACTIVE ALL COVERAGE

marketing@rsia-

cahayabunda.com

737 2180 APOTEK FARMARIN CIREBON JL. KESAMBI RAYA NO. 92 A

YULIA SOPI

KUSDIANI, S.SI,

APT

- 08179416709| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

738 0293 RS. PELABUHAN CIREBON JL. SISINGAMANGARAJA, NO.45 IBU YENNY MARKETING

0231-208948/208680 /

0231-2056570231-

205657|0231-205657

0231-234670 Y Y Y ACTIVE ALL [email protected];

[email protected]

739 1091 RS. PUTERA BAHAGIA JL. CIREMAI RAYA NO.114 ,PERUMNAS IBU NINIK RIZKY HUMAS0231-207351, 4856540231-

485654|0231-485654

0231-

486356/482328Y Y Y ACTIVE ALL COVERAGE

[email protected]/rspb_

[email protected]

740 1174 RS. SUMBER KASIH JL. SILIWANGI NO.135IBU IKAH/ BPK.

AGUSMARKETING 0231-203815| 0231-210040 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

741 1316 RS. MITRA PLUMBON JL. RAYA PLUMBON, KM.11 IBU SHINTA NORA PEMASARAN 0231-324483/323100|0231-

322355/322066Y Y Y ACTIVE ALL COVERAGE [email protected]

742 0602 RS. PERTAMINA CIREBON JL. PATRA RAYA, KLAYAN

IBU

DHARLIANTI/BPK.M.

NUR

MARKETING0231-224646; 25121730231-

224646|0231-224646

0231-224795;

209328Y Y Y ACTIVE ALL COVERAGE [email protected]

DEPOK

743 0107 RS. SIMPANGAN DEPOKJL. RAYA BOGOR, KM.36, SIDAMUKTI

SUKMAJAYA, CIMANGGIS - DEPOK

ENDANG

ARTININGSIHMARKETING 021-8741549| 021-8741574 Y Y Y ACTIVE ALL COVERAGE [email protected]

744 3329 KLINIK AL-ZAMZAMJL. ABDUL GANI NO. 53, CILODONG,

DEPOKIBU NOVI MARKETING (021) 77841431; 87904855| (021) 87904855 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

745 1485 RS. MITRA KELUARGA DEPOKJL. MARGONDA RAYA, PANCORAN MAS -

DEPOK

DR. NENDYA

LIBRIYANI/IBU

AYU/MALA

MARKETING 021-77210700| 021-77212155 Y Y Y ACTIVE ALL COVERAGEmarketingdepok@mitrakeluarga.

com

746 1085 RS. MEILIAJL. ALTERNATIF CIBUBUR KM.1

CIMANGGIS DEPOKIBU RISKA MARKETING 021-8444444,84598954-|- 021-84598952 Y Y Y ACTIVE ALL COVERAGE [email protected]

747 1098 RS. GRHA PERMATA IBU JL. KH. M. USMAN 168,KUKUSAN BEJIIBU IRA/IBU

TITA/DR DEWIMARKETING 021-7778899-|- 021-7778998 Y Y Y ACTIVE ALL COVERAGE [email protected]

748 0009 RSU. BHAKTI YUDHA JL. RAYA SAWANGAN-DEPOKDRG.WIEN

PRATIWI/ IBU YANIMARKETING 021-7520082|

021-

7775862/7762880Y Y Y ACTIVE ALL COVERAGE [email protected]

749 0777 RSIA. TUMBUH KEMBANGJL. RAYA BOGOR, KM.31, NO.23,

CIMANGGIS

BPK. TAUFIQ

ISKANDAR/

BPK.AGUS

MARKETING021-8701873-74021-

8712300|021-8712300021-8701872 Y Y Y ACTIVE ALL COVERAGE

[email protected]

.id

750 0776 RS. PURI CINEREJL. MARIBAYA BLOK F2, NO.10, PURI

CINERE - DEPOKBPK RONALD MARKETING 021-7545488| 021-7545486 Y Y Y ACTIVE ALL COVERAGE

[email protected]/ronalsima

[email protected]

751 0470 RS. SENTRA MEDIKA DEPOKJL. RAYA BOGOR KM.33 CISALAK -

DEPOK

IBU SEFTYA

WILDA/DEVI/RIAMARKETING 021-874 3790|

0218743230/8774

1666Y Y Y ACTIVE ALL COVERAGE

marketing@sentramedika-

cisalak.co.id

752 0346 RS. TUGU IBUJL. RAYA BOGOR, KM.29, CIMANGGIS -

DEPOK

DRG.MEGA /

IBU.EKAMARKETING

021-8710870/021-

8718634/33|021-

8718634/33

021-8708266 Y Y Y ACTIVE ALL COVERAGE [email protected]

753 2630 KLINIK & APOTEK KF 202 JL. KEJAYAAN BLOK IX NO. 2, DEPOK

DRS. GUNAWAN

RACHMAT BUANA

APT

- 0217704044| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

754 2627 KLINIK & APOTEK KF 352 JL. MARGONDA RAYA, DEPOK APRIYANDI - 02178884611| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

755 2628 KLINIK & APOTEK KF 394 JL. SILIWANGI NO.35, DEPOKSYAHRI APRIYANTO

S.FARM, APT- 02177214567| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHARkf.siliwangi@yahoocom

756 2460 KLINIK UTAMA TUGU SAWANGANJL. RAYA MUCHTAR NO. 20 RT.002/007

SAWANGAN - DEPOK 16511

IR. ASNIM

SJAKRANI, MBADIRUT

0251-8613433/021-

29420173|0251-8613433 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

757 2090 KLINIK QITAJL. SEDAP MALAM RAYA NO. 5 KOMP.

PERTANIAN DEPOK, CITAYAM- - 021-87989096| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

758 2078 APOTIK FARMARIN V DEPOKRUKO SALADIN SQUARE C27 JL.

MARGONDA RAYA DEPOKNABILA - 021-29402214| 021-29402214 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

759 1950 KLINIK & APOTEK KF 143 JL. MARGONDA DEPOK HASTUTI ASSAURI - 021-7522997| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

760 1056 RS. BUNDA MARGONDAJL. MARGONDA RAYA NO.28 PONDOK

CINA-DEPOK 16424LELI AR 021-78890551-|- 021-78889958 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

761 1318 RB & KLINIK CITAMA CIPAYUNGJL. RAYA CIPAYUNG NO.27 PANCORAN

MAS DEPOKBP JEN Koordinator

021-87989203/5-021-

87982268|

02187986666/828

2869Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 28 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI762 1615 RSIA. ASY SYIFA MEDICAL CENTER

JL. CINERE DEPOK NO 9 RANGKAPAN

JAYA BARU PANCORAN MAS, DEPOKIBU IKA / IBU ENO MARKETING 021-77883905/77885454| 021-77885454 Y Y Y ACTIVE ALL COVERAGE

[email protected]/rey-

[email protected]

763 0265 RS. HERMINA DEPOKJL. RAYA SILIWANGI, NO.50,

PANCORAN MASIBU OPPY MARKETING 021-77202525| 021-7763309 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

764 1776KLINIK UTAMA RAWAT INAP NAURA

MEDIKA

JL. KEMAKMURAN RAYA NO 37 DEPOK

IIIBU LIZA marketing 021-77827515| 021-77824756 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

marketing_nauramedika@yahoo.

com

765 1266 RB & KLINIK EL RAPHAJL. RAYA BOGOR KM 30 CIMANGGIS -

DEPOK

IBU PAULINA / IBU

YUSTINPemilik 021-8715082| 021-8715082 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

766 1194 RS. HASANAH GRAHA AFIAH JL. RADEN SALEH NO.42 DEPOKIBU IRS. YA/RENDY

ADITYAMARKETING 021-77826267/ 77826276| 021-77833796 Y Y Y ACTIVE ALL COVERAGE

[email protected]/

[email protected]

767 2760 RS. CITRA MEDIKA DEPOKJL. RAYA KALI MULIA NO. 68 KOTA

KEMBANG, CILODONG, DEPOK

IBU ROSI/IBU

ROBIATULMARKETING

021-

29671000/5000/7000/8000|021-29678000 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m; [email protected].

768 2722 RS. PERMATA DEPOKJL. RAYA MUCHTAR NO. 22 SAWANGAN

DEPOKLINA MARKETING 021-29669000| 021-29668897 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m;

769 1094RS. KHUSUS JANTUNG DIAGRAM

DEPOKJL. MARIBAYA NO.1 PURI CINERE

IBU ELIS / IBU

WITTY

PUBLIC

RELATIONS021-7545499-|- 021-7536965 Y Y Y ACTIVE ALL COVERAGE

Elisabeth.Paramita@siloamhospit

als.com

770 2806 KLINIK PERTAMEDIKA CINERE JL. CINERE RAYA NO. 11BDINI

(08161352467)- 021-7535022| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

771 2808KLINIK PERTAMEDIKA DEPOK (

MARGONDA)JL. MARGONDA RAYA NO. 270, DEPOK

YANI

(081807285373)- 021-77219363| 021-77219364 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

772 4007KLINIK UTAMA RAWAT INAP LIMO

MEDICARE

JL. MERUYUNG RAYA NO. 70,

PANCORAN MAS, DEPOKIBU K. ICHA DIAN - (021) 77888674; 77888675| (021) 77888675 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

773 2131 KLINIK VIVA MEDIKA DEPOK JL. RA KARTINI NO. 47C/D - - 021-29097508/09| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

774 2478 KLINIK PRATAMA DEPOK DUAJL. H.M. YUSUF RAYA RUKAN DEPOK

DUA NO.11-IBU RIA Markeing (021) 29441366| -021-29441367 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]/

[email protected]

775 2629 KIMIA FARMA BEJI JL. RAYA NUSANTARA - DEPOKNITYA BRILIANTY,

S.SI, APT- 02177207404| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

776 1007 RS. HARAPAN DEPOK JL. PEMUDA NO.10 IBU DESI PIMPINAN

021-

7520009,7773817,7720000

5-|-

021-7765883 Y Y Y ACTIVE ALL COVERAGE [email protected]

GARUT

777 2120 KLINIK PADJAJARAN LELES JL. RAYA LELES NO. 116 KAB. GARUT BAPAK AGUS - 0262-2458083| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

778 1627 BETHESDA MEDICAL CENTER GARUT JL. CIWALEN NO 43 GARUT BPK ENDY Koordinator 0262-242663,238735| 0262-242663 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

o.id

779 2699 KLINIK & APOTEK KF 377 JL. CIMANUK NO. 11A, GARUT

IKHSAN ANUARI

AKDANI,S.FARM,APT

.

- 0262 233237| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

780 2994 LAB. KIMIA FARMA GARUT JL. CIMANUK 11A PAMINGGIR JUANDA - (0262) 540077| (0262) 540077 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

INDRAMAYUKARAWANG

781 0899 KLINIK AULIA KARAWANGJL. PURWASARI KM 6, PURWASARI -

KARAWANG

IBU SUSI

SUCIATI,SKMPimpinan

0264-8286755 0811

1889279-|-0264-8286756 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

782 0869 RS. DELIMA ASIH SISMA MEDIKAJL. WIRASABA NO.54 JOHAR -

KARAWANG

BPK.SAEFULOH,IRM

AMARKETING 0267-403073-|- 0267-405598 Y Y Y ACTIVE ALL COVERAGE

marketing.rsda@sismame/delim

[email protected]

783 1022 RSU. FIKRI MEDIKAJL. RAYA KOSAMBI- TELAGASARI, DS

BLENDUNG , KLARIIBU YULI MARKETING

0267-8615555/8615566

(KLINIK):0267-

433636/435527-|-

0267-8615577/88 Y Y Y ACTIVE ALL COVERAGE [email protected]

784 1023 RS. ISLAM KARAWANG JL. PANGKAL PERJUANGAN KM.2 BPK TEDY MARKETING

0267-414520, 0267 -

414524, 4145210267-

414524|0267-414524

0267-413277 Y Y Y ACTIVE ALL COVERAGE [email protected]

785 1310 KLINIK ANDINA KARAWANG JL. PANCAWATI, NO.5A, KLARI DR.PUR ANA AISTUR KOORDINATOR 0267-438568| 0267-438406 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

786 1311 KLINIK PURI ASIH KOSAMBI

JL. KOSAMBI NO.08. KP. PUNDONG RT

02/ RW 03 DS. BELENDUNGKECAMATAN

KLARI

IBU ELLA KOORDINATOR 0267-431325 / 8616519| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

787 1314 RSIA. DR. DJOKO PRAMONOJL. PANATAYUDA 1, NO.35, KARAWANG

BARATIBU RIMA MARKETING

0267-

403009/418818/403744|0267-411744 Y Y Y ACTIVE ALL COVERAGE

[email protected]/cus

tomerservice@rs

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 29 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI788 0197 KLINIK GEMPOL

JL. RANGGAGEDE, NO.25 KARAWANG

BARATIBU MARNI KOORDINATOR 0267-412117/8453903| 0267-412117 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

789 1027 KLINIK BINA MEDIKA KARAWANGJL. TELUK JAMBE NO 8, KARAWANG

BARAT

BPK. SUDIARTO /

MAMAN/ WAHYUPENGELOLA

0267-8453903/ 412117 /

08121918055-|-0267 - 641968 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

790 1035 KLINIK MITRA GEMPOL

JL. PROKLAMASI NO. 15 KW 8 RT 003

RW. 005 KEL. TUNGGAKJATI KEC

KARAWANG BARAT KAB. KARAWANG,

BPK.SUGIARTO PIMPINAN 0267- 8451114-|- - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

791 1133 RS. CITO KARAWANGJL. ARTERI TOL KARAWANG BARAT

TELUK JAMBE

BPK.SAMUEL/ IBU

METIMarketing 0267-414245 / 414264| 0267-414306 Y Y Y ACTIVE ALL COVERAGE [email protected]

792 0095 KLINIK GRAHA MEDISJL. RAYA KOSAMBI, NO.23, DUREN

KLARI, KARAWANG TIMURDR.DIAH PERMATA KEUANGAN 0267-435527| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

793 0690 KLINIK YAKESTIJL. RAYA KLARI, RT. 04 / 01,

GINTUNGKERTA KLARIBPK ARIF KEUANGAN 0267-432416| 0267-432416 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

794 0691 KLINIK PURWAMEDIKAJL. RAYA TAMELANG NO.53,

KERAWANGBPK. SUGIARTO KEUANGAN 0267-433653| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

795 0689 KLINIK MITRA SEHAT JL. KOSAMBI CURUG, NO.28, KLARIDR. SUGENG / BPK.

SAPARKEUANGAN 0267-433930| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

796 0704 KLINIK CITO KARAWANG JL. KERTABUMI, NO.29 BPK NURS. ALIM manager 0267-410173/415957| 0267-415957 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

797 1835 KLINIK GRIYA MEDIKA

PERUM GRIYA KONDANG ASRI BLOK T

NO. 01 DESA KONDANG JAYA KEC.

KLARI - KARAWANG TIMUR

RIAL - 0267-8619999| 0267-8615309 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

798 1572 DHARMA DENTAL CLINIC (DDC) JL. KERTABUMI NO 62 KARAWANGBPK KURNIAWAN

GOZALIKOORDINATOR 0267-8453633| 0267-403962 N Y Y PARTIAL DENTAL

nia_maryani@dharmadentalclinic

.com

799 0083 RS. DEWI SRI JL. ARIF RAHMAN HAKIM, NO.1 IBU MIRA/IBU SRI MARKETING

0267-

401475,402855,406445026

7-402147|0267-402147

0267-404010 Y Y Y ACTIVE ALL COVERAGE [email protected]

800 0255 RS. BAYUKARTA JL. KERTABUMI, NO.44Ibu.DWI/Bpk.Indra/

Bpk.SandhyMARKETING

0267-

401817/401818/400351026

7-801818|0267-801818

0267-404472 Y Y Y ACTIVE ALL COVERAGE [email protected]

801 1635 KLINIK MITRA KONDANG UTAMAJL. PENGAIRAN CITRA KEBUN MAS

KONDANG KARAWANGDR. HUDI - 0267-8616923| 0267-8450001 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

802 1058 KLINIK NAFILA MEDIKA

JL. PRINGGODANI BLOK J-47

PERUMNAS TELUK JAMBE, KARAWANG

BARAT

IBU ELI KOORDINATOR 0267-8456419-|- 0267-8456419 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

803 1059 KLINIK PURI ASIH TELUKJAMBEDUSUN SUKAMULYA, DESA

PINAYUNGAN, TELUK JAMBEIBU ELLA KOORDINATOR 0267-646845-|- 0267-646845 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

klinikpuriasih.telukjambe@gmail.

com

804 3369 APOTIK KIMIA FARMA 343JL. KERTABUMI NO 12A KARAWANG

JAWA BARATIBU DEFI - 0267-8453321| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

805 2731 RS. ROSELA

JL. INTERCHANGE TOL KARAWANG

BARAT NO.3 DS WADAS KEC. TELUK

JAMBE

DIAN SANTOSO (

081316245604)MARKETING (0267) 8637207/8637205| 0267 8367205 Y Y Y ACTIVE ALL COVERAGE [email protected]

806 2741 RSIA. MITRA FAMILY-KARAWANG

JL. RONGGOWALUYO RT.02/05 DESA

SUKAHARJA KEC. TELUKJAMBE TIMUR,

KARAWANG

IBU AYU MARKETING0267 - 8458327 , 8458328,

8458329|- Y Y Y ACTIVE ALL COVERAGE

[email protected]

.id;

807 1006RS. CITRA SARI HUSADA (D/H

KLINIK INTAN BAROKAH)

JL. RAYA KOSAMBI-TELAGASARI, KM.3,

KLARI, KARAWANG TIMURIBU SENY (HRD) MARKETING 0267-437507/8617972| 0267-438681 Y Y Y ACTIVE ALL COVERAGE [email protected]

808 2823 RS. LIRA MEDIKAJL. SYECH QURO NO.14 LAMARAN,

KARAWANG - JAWA BARAT

WAHYUANA (0878

8020 8001)- (0267) 8452555 / 405 752| (0267) 405 752 Y Y Y ACTIVE ALL COVERAGE [email protected]

809 2993 KLINIK & APOTEK KF 79 KARAWANG JL. DEWI SARTIKA II NO.30 KARAWANG RIFAI TANJUNG BM 0267-405748| 0267-405748 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]/kimiafa

[email protected]

KUNINGAN

810 1704 RS. SEKAR KAMULYANJL. RUMAH SAKIT NO 28, CIGUGUR

KUNINGANBPK IRMAN MARKETING 0232-873206| 0232-875516 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

811 1345 RS. JUANDA KUNINGAN JL. IR. H. JUANDA NO.207 KUNINGAN BP KUSNANTO Marketing 0232-876433/875871|0232-

876433/875871Y Y Y ACTIVE ALL COVERAGE

[email protected];kusnanto_

[email protected]

MAJALENGKAPURWAKARTA

812 0189 KLINIK AQMA PURWAKARTA JL. IBRAHIM SINGADILAGA, NO.14BPK.HUMAIDI/IWAN

/HAMBALI

PELAYANAN

PASIEN0264-200377| 0264-200377 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

813 1057 RSIA. ASRI PURWAKARTAJL. VETERAN CIHIDEUNG NO.15

PURWAKARTA

BPK DIAN / IBU

ANDINAMARKETING 0264-211680-|- 0264-219047 Y Y Y ACTIVE ALL COVERAGE [email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 30 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI814 1043

SILOAM HOSPITAL PURWAKARTA(d/h

RS. EFARINA ETAHAM)

JL. BUNGURSARI NO.1 PO.BOX 167 -

Purwakarta

DR ANANDA ULLI/

MELLYMARKETING

0264-

8628900/8628911|0264-

231273

0264-212674 Y Y Y ACTIVE ALL [email protected]

om

815 1175 KLINIK AQMA PLERED JL. ANJUN NO.96 PLEREDBPK AGUS/ BAPAK

DIDINMARKETING 0264-270830| 0264-270830 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

816 0759 KLINIK MEDIKA SEHAT JL. IPIK GANDAMANAH SUKAMULYA BP AKHMAD JANAN MARKETING 0264-8225017| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

817 1620RS. BHAKTI HUSADA II

PURWAKARTA

JL. RAYA SADANG SUBANG, KP. KIARA

DUA, DS. CIKUMPAY, KEC. CAMPAKAYATI MARKETING

0264-

8225344/8225345/0813733

60783|

0264-8225255 Y Y Y ACTIVE ALL [email protected]/ayi

[email protected]

818 1526 RS. AMIRAJL. IPIK GANDAMANAH RT.035 RW.003

MUNJUL JAYAIBU LIYA

MARKETING PAK

YUSUF0264-8221191/92| 0264-8221193/95 Y Y Y ACTIVE ALL COVERAGE [email protected]

819 1718 RS. KHUSUS BEDAH RAMA HADIJL. RAYA SADANG - SUBANG , DS

CIWANGI BUNGUR SARI PURWAKARTADIAN ISMIATI Marketing 0264 - 202136 / 202164| 0264-8225679 Y Y Y ACTIVE ALL COVERAGE [email protected]

820 4054 KLINIK ANAK MASITHOHKP.KRAJAN RT. 01/01 MARACANG,

BABAKAN CIKAO

IBU DEVI

NOPIYANTIMarketing (0264) 8220544| (0264) 8623240 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

.id

821 2698 KLINIK & APOTEK KF PURWAKARTAJL. VETERAN NO 152 KEL NAGRI KALER

PURWAKARTA ( DEPAN INSPECTORAT )

FIKRI

SHALMANTYAS,S.FA

RM,APT

- 0264 8227437| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

apotek.kimiafarmapurwakarta@

gmail.om

822 1545 RS. MH THAMRIN PURWAKARTA JL. BUNGURSARI, NO.36 IBU.SUSI/BPK KIKI MARKETING 0264-8222222| 0264-8222223 Y Y Y ACTIVE ALL COVERAGE [email protected]

823 1315 KLINIK MIRACLE GROUPKOMP. ANEKA JASA BLOK AII NO.9-10

KOTA BUKIT INDAHBPK. NANO KOORDINATOR 0264-35166, 351377| 0264-351355 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

SUBANG

824 0191RS. PERKEBUNAN NUSANTARA 8

SUBANGJL. OTISTA, NO.1, SUBANG

BPK. IWAN

TRISTIANTOMARKETING

0260-

420406,411632,420306,420

4360260-411632/4|0260-

411632/4

0260-420391 Y Y Y ACTIVE ALL [email protected];amn.rspn8

@gmail.com

825 2752 KLINIK MITRA ABADIJL. KAPTEN HANAFIAH NO.3 RT. 98 RW.

27 KEL. KARANGANYAR, SUBANGIBU NOVAZA - 0260-418247| 0260-418237 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

SUKABUMI

826 0227 KLINIK & RB. PERMATA BUNDA JL. SILIWANGI, NO.64, PARUNG KUDAIBU DR WAYANG /

AFI

KOORDINATOR/

humas0266-535086| 0266-535086 N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

827 1506 RS. KARTIKA MEDICAL CENTER JL. JEND. A.YANI, NO.18 DR.DIAN MARKETING 0266-6250902/6250905| 0266-6250901 Y Y Y ACTIVE ALL COVERAGE [email protected]

828 0056 RS. ISLAM ASSYIFA JL. JEND. SUDIRMAN, NO. 27 MUTIARA FARIZA MARKETING

0266-

222663/218672/241463/22

3742/2237420266-

21343|0266-21343

0266 - 213433 Y Y Y ACTIVE ALL [email protected];pemasa

[email protected]

829 2892 RS. KARTIKA CIBADAKJL. SILIWANGI NO.139, CIBADAK,

SUKABUMI

IBU LILIANA/ IBU

HILDAMARKETING (0266) 7160071| (0266) 535586 Y Y Y ACTIVE ALL COVERAGE

[email protected]

d

830 0832 RS. HERMINA SUKABUMIJL. RAYA SUKARAJA RT.003/03,

SUKARAJA

IBU DEWI

PUJIASTUTIHUMAS 0266-6252525/6249292| 0266-235020 Y Y Y ACTIVE ALL COVERAGE

sukabumi@herminahospitalgrou

p.com

831 1107 RS. BETHA MEDIKA JL. RAYA CISAAT NO.595 SUKABUMI HANDRI/MERI MARKETING 0266-216422,224128-|- - Y Y Y ACTIVE ALL COVERAGE [email protected]

832 1507 RS. BHAKTI MEDICARE JL. RAYA SILIWANGI, CICURUGIBU MIA / PAK

RAHAYUMARKETING 0266-731555| 0266-731899 Y Y Y ACTIVE ALL COVERAGE [email protected]

SUMEDANG

833 1128 RS. PAKUWON SUMEDANGJL. RD.DEWI SARTIKA NO.17

SUMEDANG 45311BPK. ACEP

HUMAS &

PEMASARAN

0261-

210834/2797773/201132|0261-210834 Y Y Y ACTIVE ALL COVERAGE

rumahsakitumumpakuwon@yah

oo.com

834 2122 KLINIK PADJADJARAN JATINANGORJL. RAYA BANDUNG-SUMEDANG KM 21

JATINANGOR

DR. PANGESTU

WIDODO- 022-7797432 / 7781900| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

TASIKMALAYA

835 0256RSI. HJ. SITI MUNIROH

TASIKMALAYAJL. TAMAN SARI, GOBRAS, NO.208 BPK. ASEP SYAMSUL

HUMAS &

MARKETING

0265-323868,327630|0265-

3276300265-327630 Y Y Y ACTIVE ALL COVERAGE [email protected]

836 2106 APOTEK KIMIA FARMA 404JL. R.A MARTADINATA NO. 87

TASIKMALAYABPK YADI APOTEKER 0265-340515| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

837 2096 KLINIK & APOTEK KF 195JL. SUTISNA SENJAYA NO. 191

TASIKMALAYAIBU VITA - 0265-311225| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

838 1625RS. TASIK MEDIKA CITRATAMA

(TMC)JL. HZ MUSTOFA NO 310 TASIKMALAYA IBU EKA MARKETING 0265-322333| 0265-326767 Y Y Y ACTIVE ALL COVERAGE [email protected];

839 2773 RSB. SAYANG BUNDA JL. N. SUKALAYA I NO.22 IBU EUIS humas 0265330841| - Y Y Y ACTIVE ALL COVERAGE -

840 2390 RS. PRASETYA BUNDA TASIKMALAYAJL. IR. H. JUANDA NO. 1 (SIMPANG

JATI)BPK RANGGA HUMAS 0265320100/0265344477| - Y Y Y ACTIVE ALL COVERAGE [email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 31 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI841 2466 RS. PERMATA BUNDA TASIKMALAYA

JL. BRIGJEND HR. WASITA KUSUSMAH

NO.1 TASIKMALAYA, JAWA BARATIBU ELIS MARKETING 0265-345650| - Y Y Y ACTIVE ALL COVERAGE [email protected]

842 3203 RSIA. UMMI TASIKMALAYA JL. PASEH NO.10 - TASIKMALAYA IBU YANTI HUMAS 0265-329126| - Y Y Y ACTIVE ALL COVERAGE [email protected]

843 0253 RS. JASA KARTINI JL. OTTO ISKANDARDINATA NO 15IBU HENNY/ BPK

RIAMARKETING

0265-331808/3316410265-

3318641|0265-3318641

0265-

331808/331114Y Y Y ACTIVE ALL COVERAGE

[email protected]/p3ja

[email protected]

BANYUMAS

844 3171 RSU. WIRADADI HUSADAJL. MENTERI SUPENO NO. 25 SOKARAJA

BANYUMASIBU RINI KEUANGAN

02816846225/02816846371

|- Y Y Y ACTIVE ALL COVERAGE [email protected]

BATANG

845 3360 RS. QOLBU INSAN MULYA (QIM)JL. URIP SUMOHARDJO SAMBONG-

BATANG, JAWA TENGAHRINI - 0285-4495222| 0285-4495224 Y Y Y ACTIVE ALL COVERAGE [email protected]

BOYOLALI846 1661 RS. PKU AISYIYAH BOYOLALI JL. PASAR SAPI BARU SINGKIL IBU CHRISTINA MARKETING 0276-322898/3293400| 0726-3293400 Y Y Y ACTIVE ALL COVERAGE [email protected]

BREBES

847 2292 RS. BHAKTI ASIH BREBESJL. PANGERAN DIPONEGORO NO 125

PESANTUNAN, BREBESBPK SARTONO MARKETING 0283-673481/671279| 0283-671391 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

848 4057 RS. DERA AS-SYIFAJL. MERDEKA NO. 191, BANJARHARJO,

BREBES

BP.YONO (MKT)

087789061666- (0283) 889588| (0283) 889583 Y Y Y ACTIVE ALL COVERAGE

[email protected]/marke

[email protected]

BUMIAYU

849 1889 RS. MUHAMMADIYAH SITI AMINAH JL. DIPONEGORO, BUMIAYU BPK HARS. ONO - 0289-432209/430683| 0289-430683 Y Y Y ACTIVE ALL COVERAGE [email protected]

CEPU

850 1438 RS. MUHAMMADIYAH CEPU JL. RONGOLAWE, NO.137 BPK.ZAINAL/SYAM HUMAS 0296-421727|0296424678/4245

69Y Y Y ACTIVE ALL COVERAGE [email protected]

CILACAP

851 2866 RSUD. CILACAPJL. JEND GATOT SUBROTO NO. 28

CILACAPIBU ATIAH - 0282-533010| 0282-520755 Y Y Y ACTIVE ALL COVERAGE [email protected]

852 1005 KLINIK DR TUTUK JL. PERINTIS KEMERDEKAAN 21 Uun Rahayu koordinator 0282-545921-|- - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

853 2696 KLINIK & APOTEK KF 89 JL. GATOT SUBROTO NO.59, CILACAPMITHA

NOVETIANA,SF,APT- 0282 535293| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

854 4165 RS. APRILLIAJL. JEND GATOT SUBROTO NO.95

CILACAPENY WIDIASTUTI - 0282-536307| 0282-521144 Y Y Y ACTIVE ALL COVERAGE [email protected]

855 0975 RS. ISLAM FATIMAH CILACAP JL. H JUANDA NO.20 IBU ASTUTI MARKETING 0282-542396|-0282-

541065/5452151Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

856 3526KLINIK PRATAMA KIMIA FARMA

CILACAPJL. GATOT SUBROTIO NO. 59 CILACAP

IBU MITHA

NOVETIANA- 0282-535293| - N Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

GOMBONG

857 1243 RS. PALANG BIRU JL. KARTINI, NO.37 IBU ANNA. S MARKETING 0287-471290/471762|0287-

473221/471762Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

858 3327 RS. PKU MUHAMMADIYAH GOMBONG JL. YOS SUDARS. O NO.461,GOMBONGIBU PUDJI ASTUTI,

SE AKMgr Keuangan 0287-471780| - Y Y Y ACTIVE ALL COVERAGE [email protected]

JEPARA

859 3959 RSI. SULTAN HADLIRIN JEPARAJL. RAYA JEPARA BANGSRI KM 3

KUWASEN, JEPARABP. ISMAIL - (0291) 591507| (0291) 4295554 Y Y Y ACTIVE ALL COVERAGE [email protected]

860 1224 RS. GRAHA HUSADA JEPARA JL. M.H. THAMRIN, NO.14BPK.HIRMAWAN/EVI

ENDRAWATIKP.SEKRETARIAT 0291 - 592067| 0291-597806 Y N Y ACTIVE ALL COVERAGE [email protected]

KENDAL

861 1666 RSI. MUHAMMADIYAH KENDAL JL. AR RAHMAH NO 17 WELERI IBU WIWIN MARKETING0294-641870 / 0294-

643756|0294-644150 Y Y Y ACTIVE ALL COVERAGE [email protected]

KLATEN

862 0754 RS. ISLAM KLATEN JL. RAYA SOLO KM.4 DR. BERLIANTY MARKETING 0272-322252|- 0272-332422 Y Y Y ACTIVE ALL [email protected]/as

uransi_rsik@yahoo.

863 1441 RS. CAKRA HUSADA KLATEN JL. MERB. ABU, NO.7BPK.A.A.GEDE

ARMAYA-

0272-321123-322386-

322394|0272-329029 Y Y Y ACTIVE ALL COVERAGE [email protected]

864 1519RSU. PKU MUHAMMADIYAH

DELANGGUJL. DELANGGU UTARA, NO.19 IBU DINAYAH MARKETING 0272-551051| 0272-554041 Y Y Y ACTIVE ALL COVERAGE [email protected]

KUDUS

865 3259LAB. CITO (JL. AKBP AGIL

KUSUMADYA NO. 7 )JL. AKBP AGIL KUSUMADYA NO. 7 IBU VIVI - 0291-4251979| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

[email protected]

866 0146 RS. MARDI RAHAYU KUDUS JL. AKBP.R. AGIL KUSUMADYA, NO.110 IBU.DIAN / YATI MARKETING0291-434707-

12/435582/443581|

0291-

438398,434711Y Y Y ACTIVE ALL COVERAGE

[email protected]/mardir

[email protected]

MAGELANG

867 0335 RS. HARAPAN MAGELANG JL. P. SENOPATI, NO.11 IBU DESY / IBU LILIMARKETING/CUST.

SERS0293-364033-35| 0293-364036-37 Y Y Y ACTIVE ALL COVERAGE

[email protected]

;[email protected]

868 1132 RS. LESTARI RAHARJA JL. MAYJEN SUTOPO NO.5 BPK.JUPRI SEKRETARIAT 0293-362225|0293-

362649/311512Y Y Y ACTIVE ALL COVERAGE [email protected]

JAWA TENGAH

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 32 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI869 3286 LAB. CITO MAGELANG

JL. TENTARA PELAJAR NO 126

MAGELANG

BPK DONI EKO

NURMAWAN- 0293 363763| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

PATI

870 1299 KELUARGA SEHAT HOSPITAL JL. P.SUDIRMAN NO.9 MARGOREJOIBU NURI DHARS.

ANTIMARKETING 0295-386111| 0295-384422 Y Y Y ACTIVE ALL COVERAGE [email protected]

871 1534 RS. MITRA BANGSA JL. KOL.SUGIYONO, NO.75 BPK. LILIK/IBU YANI MARKETING 0295-382555| 0295-4191994 Y Y Y ACTIVE ALL [email protected];

[email protected]

PEKALONGAN

872 0120 RS. SITI KHODIJAH PEKALONGAN JL. BANDUNG, NO.39-47 DR. IRVINA MARKETING

0285-

422845,425138,423590,424

919|

0285-425138 Y Y Y ACTIVE ALL [email protected]/rssk_pkl

@telkom.net

873 3227 LAB. CITO PEKALONGAN JL. K.H. MANSYUR NO.33 PEKALONGANYENI ERI

KRISNAWATIKEPALA CABANG 0285-422458| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

[email protected]

874 2694 KLINIK & APOTEK KF 16JL. IMAM BONJOL, NO.16 A,

PEKALONGAN

DRS. ANIS SALIM,

APT- 0285 421402| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

875 3186 RSIA. ANUGERAH PEKALONGANJL. PERINTIS KEMERDEKAAN NO. 3,

KRAMAT SARI, PEKALONGAN 51118LULUK Marketing 0285-431491| (0285) 431903 Y Y Y ACTIVE ALL COVERAGE [email protected]

876 1220 RS. BUDI RAHAYU PEKALONGAN JL. BARITO, NO.5 PEKALONGAN IBU. ENIMARKETING/KEUA

NGAN0285 - 423491/424340| 0285-423002 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

PEMALANG

877 4093 RS. PRIMA MEDIKA PEMALANGJL. SLAMET RIYADI NO. 321

MULYOHARJO, PEMALANGIBU ROSI AMINAH MARKETING 021-5396737| - Y Y Y ACTIVE ALL COVERAGE [email protected]

878 1219 RSU. SANTA MARIA PEMALANG JL. PEMUDA NO.24IBU JEMI PUJI

ASTUTIMARKETING 0284 - 321251/321426| 0284 - 322335 Y Y Y ACTIVE ALL COVERAGE

marketing_santamariapml@yaho

o.co.id

PURBALINGGA

879 1888 RSU. HARAPAN IBU PURBALINGGA JL. MAYJEND SOENGKONO NO. 1 BPK HARI MARKETING 0281-892222/982277| - Y Y Y ACTIVE ALL COVERAGE [email protected]

PURWODADI

880 1226 RS. PANTI RAHAYU JL. LETJEND. SUPRAPTO NO.6BPK.SARYOTO

(YOYOK)MARKETING 0292 - 421087-422325|

0292-

421370/425095Y Y Y ACTIVE ALL COVERAGE

[email protected];kilo

[email protected]

PURWOKERTO

881 1448 RSIA. BUNDA ARIF PURWOKERTOJL. JATIWINANGUN, NO.16

PURWOKERTO

DR EMAN/ BPK

NANAHUMAS 0281-636555| - Y Y Y ACTIVE ALL COVERAGE [email protected]

882 0825 RS. ST. ELISABETH - PURWOKERTO JL. DR ANGKA NO 40, PURWOKERTO

IBU

SEPTI/DR.ASTHER

PRIMANDARI

TATA USAHA

0281-

627384/632833/623117/62

58570281-635278|0281-

635278

(0281) 640005 Y Y Y ACTIVE ALL COVERAGE [email protected]

883 0201 RSU. BUNDA PURWOKERTO JL. PRAMUKA, NO.249 UUT / DR.TATI MARKETING0281-6354240281-

632514|0281-6325140281-632514 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

884 2095 KLINIK & APOTEK KF FAJAR SEHATJL. R.A WIRIATMAJA NO. 37

PURWOKERTO

IBU ANTON

WIYANTI- 0281-637247| 0281-640760 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

885 2094APOTEK KIMIA FARMA 133

PURWOKERTO

JL. JEND. SUDIRMAN TIMUR NO. 435

PURWOKERTOBPK. AGUS Apoteker 0281-638546| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

886 1447 RSU. ANANDA PURWOKERTO JL. PEMUDA, NO.30 IBU DESI/YOKE MARKETING 0281-631435-636417|0281-

640226/632146Y Y Y ACTIVE ALL COVERAGE

[email protected]/yoke@rs

ananda.co.id

887 1351 RS. ORTHOPAEDI PURWOKERTOJL. SOEPARDJO ROESTAM NO. 99

PURWOKERTOBPK HERU - 0281-6844166| 0281-6844188 Y Y Y ACTIVE ALL COVERAGE [email protected]

888 3131 LAB. CITO PURWOKERTO JL. PRAMUKA 798 RT 7/1 PURWOKERTO BPK SINGGIH MARKETING 0281-637362; 637538| 0281-637583 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

PURWOREJO

889 1908 RS. PALANG BIRU KUTOARJOJL. MADITOMO 17, KUTOARJO-

PURWOREJOIBU MIA SEKERTARIAT 0275-641425| - Y Y Y ACTIVE ALL COVERAGE [email protected]

890 1131RS. PKU MUHAMMADIYAH

PURWOREJO

JL. BRIGJEND KATAMSO NO.144 A

PURWOREJO

BPK ARIF

MUSTAWANMARKETING 0275-325260| 0275-324211 Y N Y ACTIVE ALL COVERAGE [email protected]

SALATIGA

891 1145 RS. PURI ASIHJL. JEND. SUDIRMAN NO.169

SALATIGA

IBU NURUL/IBU TRI

HANDAYANIMARKETING 0298-323209/0298-312049|

0298-

322898/311466Y Y Y ACTIVE ALL COVERAGE

[email protected];rs_purias

[email protected]

892 3350 APOTEK KIMIA FARMA SALATIGAJL. BRIGJEN SUDIARTO NO. 30

SALATIGAPAK MULYADI - 0298-325350| - N Y Y ACTIVE ALL COVERAGE [email protected]

SEMARANG

893 3349 APOTEK KIMIA FARMA 203 UNGARAN JL. DIPENOGORO 212 UNGARAN PAK MULYADI - 024-76914353| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

894 3245LAB. CITO (JL. INDRAPRASTA NO. 81

A)JL. INDRAPRASTA NO. 81 A SEMARANG BP RIZKY - 024-3556853| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];gc

[email protected]

895 3246 LAB. CITO ( JL. SETIABUDI ) JL. SETIABUDI SEMARANG BPK HERY - 024-7461645| N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

cito_setiabudi@yahoo

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 33 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI896 3247 LAB. CITO ( JL. DR. CIPTO ) JL. DR. CIPTO 14A SEMARANG IBU ROSALIA - 024-3515374| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

[email protected]

897 2168 APOTEK FARMARIN SEMARANG JL. KALIGARANG NO. 2DWIWIN YUWINDARI,

S.SI, APTAPOTEKER 024-8450558| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

898 1450 RS. PERMATA MEDIKAJL. MR.MOCH. ICHSAN, NO.93-97,

NGALIYAN

IBU BUDI/IBU ERNI

WIDYANINGRUM

HUMAS &

MARKETING

024-

7625005/7618800/7626571

|

024-7621733 Y Y Y ACTIVE ALL [email protected];widyani

[email protected]

899 2692 KIMIA FARMA 178JL. BRIG.SUDIARTO,462 E (MAJAPAHIT

LAMA)

DESI RAHMAWATI,

S.FARM, APT024 6716235| -- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

900 2693 KLINIK & APOTEK KF 71 JL. DR.SOETOMO NO.3 , SEMARANGHERU SUDOMO,

S.FAR, APT- 024 3520763| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

901 0160 RS. ST. ELISABETH - SEMARANG JL. KAWI NO. 1 IBU TARI/EKAMARKETING/HUMA

S024-8310076/ 8310035| 024-8413373 Y Y Y ACTIVE ALL COVERAGE [email protected]

902 0377 RS. TELOGOREJO JL. KH. AHMAD DAHLAN IBU ANI MARKETING024 - 8446000/8448448024-

8446000|024-8446000024 - 8449660 Y Y Y ACTIVE ALL COVERAGE [email protected]

903 1663 RS. KEN SARAS JL. SOEKARNO HATTA KM 029 IBU CACA MARKETING 024-6922269| 0298-522706 Y Y Y ACTIVE ALL COVERAGE [email protected]

904 0053 RS. ROEMANI MUHAMMADIYAH JL. WONDRI, NO.22BPK. AGUNG

JATMIKOCS / PENAGIHAN 024 - 8444623| 024-8415752 Y Y Y ACTIVE ALL COVERAGE

[email protected]/rs

[email protected]

905 0379 RS. PANTI WILASA CITARUM JL. CITARUM, NO. 98DRG.CRISWIDYATI /

BPK.KIKIMARKETING

024-3542224 /

081228345674 ( BPK KIKI )|

024-

3561514,3542063Y Y Y ACTIVE ALL COVERAGE

marketing.pantiwilasa.citarum@

gmail.com

906 0050 RS. PANTI WILASA DR. CIPTO JL. DR. CIPTO, NO.50 BPK. BAYU MARKETING 024 - 3546040, 3557428| 024-3546042 Y Y Y ACTIVE ALL [email protected].

net.id

907 0299RSU. HERMINA PANDANARAN

SEMARANGJL. PANDANARAN NO.24 IBU ENO

HUMAS &

MARKETING024-8411112/8442525| 024-8450818 Y Y Y ACTIVE ALL COVERAGE

pandanaran@herminahospitalgro

up.com

908 0182 RS. ISLAM SULTAN AGUNG JL. KALIGAWE KM.4 IBU. SRI WAHYUNI MARKETING 024-6580019| 024-6581928 Y Y Y ACTIVE ALL [email protected];rsisula

@indosat.net.id

909 0901 RS. BANYUMANIK JL. BINA REMAJA NO.61 BPK SOBIRIN MARKETING024-7471519024-

7462181|024-7462181024-7462181 Y Y Y ACTIVE ALL COVERAGE [email protected]

910 3260KIMIA FARMA 19 (JL. SULTAN

AGUNG)

JL. SULTAN AGUNG KOMPL.

PERTOKOAN R A/15 SEMARANG

RICKY FABIANO

AMRI- 024-8315248| 024-8315795 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

911 3261KIMIA FARMA 153 (JL. JATI RAYA

BANYUMANIK)

JL. JATI RAYA BANYUMANIK,

SEMARANG

LINTANG

ANTYANING / DITHA

DWIKE

- 024-7464268| 024-7464268 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected] /

[email protected]

912 3262 KIMIA FARMA 259 (JL. FATMAWATI) JL. FATMAWATI NO. 42, SEMARANG SHINTA DEWI Penanggungjawab 024-76928544| 024-76928544 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

913 3264KIMIA FARMA 271 MEDITAMA (JL.

AHMAD)

JL. KH. AHMAD DAHLAN NO. 9, KEL.

BENDUNGAN, KEC. GAJAHMUNGKURMEGA RESTU - 024-8455323| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

914 3265KLINIK & APOTEK 324 (JL. RAYA

NGALIAN)

JL. RAYA NGALIYAN , KEL. TAMBAK AJI,

KEC.NGALIYAN SEMARANG

DAVID ARISANDI

ATMADJI- 024-7612049| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

915 3267 KIMIA FARMA 374 (JL. TELOGO SARI)

JL. TLOGOSARI RAYA NO. 1 KAV. 2,

KEL. TLOGOSARI KULON, KEC.

PEDURUNGAN, SEMARANG

INTAN IRDA MELATI - 024-6709192| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

916 3215 RS. WILLIAM BOOTH SEMARANG JL. S. PARMAN NO. 5 SEMARANG IBU AGNES MARKETING 024-8411800| Y Y Y ACTIVE ALL COVERAGE [email protected]

917 2246 APOTEK KIMIA FARMA 17JL. TENTARA PELAJAR NO. 16 A,

SEMARANGBP RUSTIONO - 024-8447245| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

918 2238 KLINIK & APOTEK KF 18 JL. PEMUDA NO. 135 SEMARANG BPK RUSTINO -

024-

3545101/3541510/3518913

|

- N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

919 2822 RS. COLUMBIA ASIA SEMARANG JL. SILIWANGI NO. 143 SEMARANGINDAH W.G

(081901616318)Marketing (024) 762 9999/86462020| (024) 7667 4228 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

920 3217 KLINIK KITA TEMBALANG (DR MOEZ)JL. NGESREP TIMUR 5/36

BANYUMANIK, SEMARANGNURYATI - 085640398938| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

921 3218 KLINIK KITA KALIPANCUR (DR MOEZ)JL. ABDULRAHMAN SALEH KAV. 783

KALIPANCUR, SEMARANGDESITA - 085641869731| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

922 2969 RS. HERMINA BANYUMANIK

JL. JENDRAL POLISI ANTON

SOEDJARWO NO. 195 A, SEMARANG

50263

IBU DINDA/ IBU

TARIMARKETING (024) 7648 8989| (024) 7647 9080 Y Y Y ACTIVE ALL COVERAGE

banyumanik@herminahospitalgr

oup.com

923 3230KLINIK KITA KEDUNGMUNDU (DR

MOEZ)

JL. KEDUNGMUNDU RUKO GRAHA

WAHID NO. 7, SEMARANG- - -| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

924 3231KLINIK KITA IBNU SIENA

PUSPONJOLO (DR MOEZ)

JL. PUSPONJOLO TENGAH RAYA NO.

65, SEMARANG- - -| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

925 3232KLINIK KITA IBNU SIENA NGALIYAN

(DR MOEZ)

JL. PROF HAMKA RUKO SEGITIGA

EMAS B 7, SEMARANG- - -| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 34 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI926 3233 KLINIK KITA CANGKIRAN (DR MOEZ)

JL. JATI KALANGAN RUKO PURI DELTA

ASRI, SEMARANG- - -| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

SLAWI

927 1665 RS. ADELLA JL. PROF MOH YAMIN NO. 77 SLAWI IBU NINA/LESTI MARKETING 0283-491154/491773| 0283-491354 Y Y Y ACTIVE ALL COVERAGE [email protected]

SOLO

928 2181 APOTEK FARMARIN SOLO JL. GREMET NO.3 RT 007/11 MANAHANFITRIA WULANDARI,

S.SI, APT- 085727427423| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

929 0118 RS. DR. OEN SOLO BARUKOMP. PERUMAHAN SOLO BARU,

GROGOL, SUKOHARJO

IBU LILA/ IBU ANI

/BPK MULYADIMARKETING 0271-620220|

0271-

622555/660935Y Y Y ACTIVE ALL COVERAGE

[email protected]

m/[email protected]

930 1483 RS. PANTI WALUYO SURAKARTA JL. JEND.A.YANI NO.1 IBU ADELIA MARKETING 0271-712077| 0271-729125 Y Y Y ACTIVE ALL [email protected];rspa

[email protected]

931 0119 RSU. KASIH IBU SURAKARTA JL. BRIGJEND SLAMET RIYADI NO.404DRG. HARIANI/IBU

YOVITAMARKETING 0271 - 714422| 0271-722837 Y Y Y ACTIVE ALL COVERAGE

[email protected]/rsuk

[email protected]

932 0212 RS. ISLAM KUSTATI JL. KAPTEN MULYADI NO.249IBU.JAZARIA/BPK

TOTO

INFORMASI/SEKRE

TARIA0271 - 643013| 0271-634823 Y Y Y ACTIVE ALL COVERAGE [email protected]

933 0214RS. DR. OEN SURAKARTA(KANDANG

SAPI)

JL. BRIGJEN KATAMSO NO.55,

KANDANG SAPIDR. SUSILOWATI MARKETING 0271-643139| 0271-642026 Y Y Y ACTIVE ALL COVERAGE [email protected]

934 0745 RS. ISLAM SURAKARTAJL. A YANI PABELAN KARTASURA,

SOLO

BPK.KHOLID/ IBU

FATAHMARKETING

0271-7105710271-

725134|0271-7251340271-710572 Y Y Y ACTIVE ALL COVERAGE

[email protected];info@rsisy

arsis.com

935 0746 RS. PKU MUHAMMADIYAH SOLO JL. RONGGOWARSI. TO NO130, SOLO IBU BETTY HUMAS 0271-714578| 0271-717012 Y Y Y ACTIVE ALL COVERAGE [email protected]

936 1179 RS. BRAYAT MINULYA JL. DR.SETIABUDI NO.106 SURAKARTA IBU GITA / RIA Marketing0271-

716646,710571,710170|

0271-

727309/712181Y Y Y ACTIVE ALL COVERAGE [email protected]

937 3280LAB. KLINIK KIMIA FARMA

SURAKARTAJL. ADISUCIPTO NO. 70 SURAKARTA - - 0271-727886| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

938 3279 LAB. CITO SOLO JL. YOSODIPURO NO.64 SURAKARTA ANDREAS DWI - 0271-2500055| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

[email protected]

939 1180 KLINIK BUDI SEHAT JL. S.PARMAN, NO.131, PASAR LEGIIBU

PRASETYANINGSIHMARKETING 0271-648026-661415|

0271-

643265/661366N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected] /

[email protected]

940 2907 RS. HERMINA SOLO JL. KOL SUTARTO NO. 16 JEBRES SOLO DRG DYAH MARKETING 0271-638989| 271 Y Y Y ACTIVE ALL COVERAGE [email protected]

941 3354 APOTEK KIMIA FARMA YOSODIPURO JL. NO.111B, SOLO - - -| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

SRAGEN945 1660 RS. SARILA HUSADA JL. VETERAN NO 41-43 SRAGEN BP TULUS PERSONALIA 0271-891538| Y Y Y ACTIVE ALL COVERAGE -

946 3353 APOTEK KIMIA FARMA SRAGEN JL. SUKOWATI NO.440A, SRAGEN - - -| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

SUKOHARJO

947 3355 APOTEK KIMIA FARMA SUKOHARJO JL. VETERAN NO.11 SUKOHARJO - - 0271-590411| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

948 1178 RS. NIRMALA SURI JL. RAYA SOLO KM 9 SUKOHARJO BP. ARIFIN MARKETING 0271-592192| - Y Y Y ACTIVE ALL COVERAGE [email protected]

TEGAL949 3359 RSIA. PALARAYA JL. PALARAYA NO. 11 A TEGAL BAPAK PRANATA -- 0283-356009| - Y Y Y ACTIVE ALL COVERAGE [email protected]

950 2093 APOTEK KIMIA FARMA 97 TEGAL JL. MAYJEN SUTOYO NO. 44 TEGAL BPK TEGUH - 0283-354733/355765| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

951 0753 RS. ISLAM HARAPAN ANDA JL. ABABIL NO.42 IBU. NURUL MARKETING 0283-358244| 0283-351263 Y Y Y ACTIVE ALL [email protected]/nurul@h

arapananda.com

952 1540 RS. MITRA KELUARGA TEGALJL. SIPELEM, NO.4, KEMANDUNGAN,

TEGAL BARATDR.SERLY/IBU TINA MARKETING 0283-340399/340999| 0283-340902 Y Y Y ACTIVE ALL COVERAGE

[email protected]

/[email protected]

953 3220 LAB. CITO TEGAL JL. GAJAH MADA NO. 79 TEGAL SILVIA AYU - 0283 353402| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

954 1873 RS. MITRA SIAGA TEGAL JL. PALARAYA NO. 54 TEGAL TRI NURCAHYO KA. HUMAS 0283-353387/322550| 0283-351518 Y Y Y ACTIVE ALL COVERAGE [email protected]

TEMANGGUNG

955 1144 RS. NGESTI WALUYO JL. PAHLAWAN-PARAKANBPK.KRISYATNO/BP

K.WISTOMO

HUMAS

MARKETING0293-596008| 0293-596410 Y Y Y ACTIVE ALL COVERAGE [email protected]

WONOGIRIWONOSOBO

BANGIL

956 0700 RS. ISLAM MASYITHOH JL. A. YANI, NO.6IBU ERMA

ZUBAEDAHMARKETING 0343-741018| 0343-742425 Y Y Y ACTIVE ALL COVERAGE [email protected]

BANGKALAN

JAWA TIMUR

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 35 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI957 3841

APOTEK KIMIA FARMA TRUNOJOYO

419JL. TRUNOJOYO NO.75A BANGKALAN

DIAN

LARASATI.S.FARM- 0313095459| 313095459 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

958 3840 APOTEK KIMIA FARMA 163 JL. JOKOTOLE NO.5 BANGKALANLAKSMI

KUSUMASTUTI- 0313091016| 313091016 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

959 3595 RS. LUKAS JL. KH.MOH.KHOLIL 36ADR.ARTO

085235779518;MARKETING 031-3095148| - N Y Y ACTIVE ALL COVERAGE

[email protected];

artok_wijayanto@yahoo

BANYUWANGI

960 4065RS. NAHDLATUL ULAMA

BANYUWANGI

JL. RAYA MANGIR NO. 09 KEC.

ROGOJAMPI KAB. BANYUWANGIAGUS BAIDLAWI - 0333-632965| 0333-632965 Y Y Y ACTIVE ALL COVERAGE [email protected]

961 4130RSIA. PKU MUHAMMADIYAH

ROGOJAMPI

JL. PANGERAN DIPONEGORO NO. 20,

ROGOJAMPIPUTRI TRIANASARI MARKETING 0333-631149| - Y Y Y ACTIVE ALL COVERAGE [email protected]

962 0726 RS. ISLAM FATIMAH BANYUWANGI JL. JEMBER, NO.25FANI / BPK.AINUR

RAFIQ

personalia/MARKET

ING0333-421451|

0333-

423204/417929Y Y Y ACTIVE ALL COVERAGE

[email protected],iqbwi@ya

hoo.com

963 1429 RS. YASMIN BANYUWANGI JL. LETKOL ISTIQLAL NO.80-84 BP. AGUS HUMAS 0333-424671| -0333-418219 Y Y Y ACTIVE ALL COVERAGE [email protected]

964 0724 RS. AL-HUDA JL. DIPONEGORO, NO.65, GENTENG IBU LISA/IBU PRIMA MARKETING

0333-

842033/844682/845248/84

2118|

0333-842036/38 Y Y Y ACTIVE ALL COVERAGE [email protected]

BLITAR

965 0269 RS. KATOLIK BUDI RAHAYU BLITAR JL. JEND. A.YANI NO. 18 BLITARBP.YOSEP/IBU

RITA/IBU KALISTAMARKETING

0342-

801066/802316/807802|

0342-

806509/804284Y Y Y ACTIVE ALL COVERAGE [email protected]

966 3807 RS. UMUM AMINAH BLITARJL. VETERAN NO. 39, KEPANJEN, KIDUL

BLITAR 66111IBU EMI MARKETING 0342-816304/816305| 0342-816527 Y Y Y ACTIVE ALL COVERAGE [email protected]

BOJONEGORO

967 1032 RS. PKU MUHAMMADIYAH KALITIDU JL. RAYA KALITIDU, NO.266, KALITIDU NURHADI MARKETING 0353-511731/512066-|-0353-

511678/512066Y Y Y ACTIVE ALL COVERAGE

rsmuhammadiyahkalitidu@gmail

.com968 0731 RS. AISYIYAH BOJONEGORO JL. HASHIM ASHAARI, NO.17 IBU INDAH MARKETING 0353-881748/885978| 0353-885978 Y Y Y ACTIVE ALL COVERAGE [email protected]

BONDOWOSO

969 3892 RS. MITRA MEDIKA BONDOWOSOJL. HOS COKROAMINOTO 98,

BONDOWOSOIFAN RIZKY marketing 0332-423800; 421981| 0332 429601 Y Y Y ACTIVE ALL COVERAGE

customerservice@rsmitramedika

.com

GRESIK

970 3648 RSUD. IBNU SINA KAB. GRESIK JL. DR. WAHIDIN SH NO.243B, GRESIK -DR. SRI RAHAYU Humas 031-3951239| - Y N Y ACTIVE ALL COVERAGErsudibnusina.marketing@yahoo.

com

971 4235 RS. FATHMA MEDIKA GRESIKJL. PENDOPO NO. 45, SEMBAYAT,

MANYAR, GRESIK

IBU DESI

RAHMAT/PAK SETYO- (031) 394 3500| - Y Y Y ACTIVE ALL COVERAGE [email protected]

972 4053 RS. PETROKIMIA GRESIK DRIYOREJO JL. RAYA LEGUNDI KM 5 NEVIA -031-8986701, 8981779,

8981778|031-8986700 Y Y Y ACTIVE ALL COVERAGE [email protected]

973 0596 RS. SEMEN GRESIK JL. RA. KARTINI, NO.280 GRESIK IBU. IRIA MARKETING031 -

3987840,3989478,3975847|031-3987842 Y Y Y ACTIVE ALL COVERAGE

[email protected]/rss

[email protected]

974 1923RS. PETROKIMIA GRESIK GRHA

HUSADA

JL. PADI NO. 3 KOMPLEK PT

PETROKIMIA GRESIKBPK REZA -

031-

3984465,3973400,3793401|031-3972623 Y Y Y ACTIVE ALL COVERAGE [email protected]

975 2610 RS. WATES HUSADA

JL. RAYA WATES UTARA

KEDUNGPRING, BALONGPANGGGANG -

GRESIK

PUJIHARTO

(031)77109257- (031) 7922351| - Y Y Y ACTIVE ALL COVERAGE [email protected]

976 3842 APOTEK KIMIA FARMA 164 JL. R.A KARTINI NO.150-152 ADNAN AZHARY - 0313984783| 313984783 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

977 1427 RS. PETROKIMIA GRESIK JL. JEND. A.YANI NO.69

IBU

MEKA/DR.RETNO/IB

U SITI

MARKETING

031-

3988877/3990994/3978658

/3977666|

031-

3980008/3981232Y Y Y ACTIVE ALL COVERAGE

[email protected]/rspg2004

@yahoo.co.id

JEMBER

978 1428 RS. BINA SEHAT JL. JAYANEGARA NO.7 BP. NICO HUMAS0331-

422701/424304/421713|0331-428390 Y Y Y ACTIVE ALL COVERAGE [email protected]

979 2076 KLINIK & APOTEK KF 62 JEMBER JL. GAJAH MADA 171 JEMBER AYU APOTEKER 0331-489020| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

980 1685RSU. KALIWATES PT PERKEBUNAN

NUSANTARA XIIJL. DIAH PITALOKA NO 1 JEMBER BP MAHMUD HUDA Marketing 0331-3137525/483567| 0331-489100 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

981 0725 RS. PERKEBUNAN (PTPN) X JEMBER JL. BEDADUNG, NO.2 JEMBERBPK. FEBRI/ IBU

SANTIMARKETING

0331-

487104,485415,426873,485

912,4107480331-

487226|0331-487226

0331-485912 Y Y Y ACTIVE ALL COVERAGE [email protected]

982 3530 RS. CITRA HUSADA JL. TERATAI NO.22 JEMBER IBU RATIH MARKETING (0331) 486200| (0331) 427088 Y Y Y ACTIVE ALL COVERAGE rs_citrahusada@ya

983 2077 APOTEK KIMIA FARMA 241 JEMBERJL. PANGLIMA SUDIRMAN NO. 46

JEMBERHIMAWAN - 0331-489885| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

JOMBANG

984 1849 RSIA. MUSLIMAT JOMBANG JL. URIP SUMOHARJO NO 34 JOMBANG

IBU RJ EKA

RAHMANDA /BPK

RISHI

HUMAS&MARKETIN

G

0321-

872200/877600/869434|0321-854991 Y Y Y ACTIVE ALL COVERAGE

[email protected]

[email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 36 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI985 0810 RS. DR. MOEDJITO DWIDJOSISWOJO JL. HAYAM WURUK, NO.9 JOMBANG

IBU ERI/ QORI

RAMEANMARKETING

0321-

864308,6977788,855555|0321-877276 Y Y Y ACTIVE ALL COVERAGE

[email protected]/hospit

[email protected]

986 1880 RS. AIRLANGGA JOMBANGJL. AIRLANGGA NO 50 C JELAKOMBO,

JOMBANGIBU DEVI MARKETING 0321-861577| 0321-862194 Y Y Y ACTIVE ALL COVERAGE [email protected]

987 0978 RS. KRISTEN MOJOWARNO JL. MERDEKA NO.59, MOJOWARNO IBU EVI MARKETING 0321-495093-|-0321-

492200/495440Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

988 1966 RS. PELENGKAP MEDICAL CENTER JL. JUANDA NO. 03 JOMBANGBPK KUSWOYO/ IBU

CINTYAMARKETING 0321-877945 / 869826| - Y Y Y ACTIVE ALL COVERAGE [email protected]

KEDIRI

989 1998 KLINIK & APOTEK KF 75 KEDIRIJL. JAKSA AGUNG SUPRAPTO NO. 25

KEDIRIFAIZ APOTEKER 0354-773384/ 694913| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

990 1599RS. MUHAMMADIYAH AHMAD

DAHLAN KEDIRIJL. GATOT SUBROTO NO 84 KEDIRI

IBU SITI NASYATUL

AISIAHPEMASARAN

0354-

773115/776182/770182|

0354-

776318/773736Y Y Y ACTIVE ALL COVERAGE [email protected]

991 0977 RS. BAPTIS KEDIRI JL. BRIDJEN POLLBH PRANOTO NO.1WAHYU WASITO

WIBOWOMARKETING

0354-682170, 683578,

684172-|-0354-681173 Y Y Y ACTIVE ALL COVERAGE [email protected]

992 0248 RS. HVA TOELOENGREDJO JL. A. YANI NO. 25 PARE

DRG

MENIS/YANNEKE/W

AHYU JAYADI

MARKETING 0354-391047,391145| 0354-392883 Y Y Y ACTIVE ALL [email protected]/rstoel_it@ya

hoo.co.id

993 2075 APOTEK KIMIA FARMA 151 KEDIRI JL. STASIUN NO. 47 KEDIRI TULUS APOTEKER 0354-694913| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

994 1430 RS. AURA SYIFA JL. JOYOBOYO NO.42 DLOPODR. BENY CAHYO/

IBU YULIMARKETING 0354-671939|

0354-

696033/641939Y Y Y ACTIVE ALL COVERAGE [email protected]

995 1182 RS. BHAYANGKARA KEDIRI JL. KOMBES POL DURYAT NO 17 IBU EMI MARKETING 0354-671100| 0354-683830 Y Y Y ACTIVE ALL COVERAGE [email protected]

996 3828 APOTEK KIMIA FARMA SMAN II PAREJL. PAHLAWAN KUSUMA BANGSA 28

PAREBP. WAHYU APOTEKER 0354-390006| 0354-390006 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

LAMONGAN

997 1199 RS. MUHAMMADIYAH LAMONGAN JL. JAKSA AGUNG SUPRAPTOIBU

NOVI/BPK.ZUHDIMARKETING 0322-322834| 0322-314048 Y Y Y ACTIVE ALL COVERAGE [email protected]

LUMAJANG

998 1247 RS. WIJAYA KUSUMA JL. A. YANI, NO.149, LUMAJANG IBU SENJA/ERNASEKRETARIAT/KEU

ANGAN0334-891325| 0334-888844 Y Y Y ACTIVE ALL COVERAGE [email protected]

MADIUN999 1183 RS. SITI AISYAH JL. MAYJEN SUNGKONO, NO.38 SUNARTO Marketing 0351-464822/451843| 0351-464009 Y Y Y ACTIVE ALL COVERAGE [email protected]

1000 3425 KLINIK & APOTEK KF 76 JL. JAWA NO.14 BPK.BAMBANGPENANGGUNG

JAWAB035-453381| 0351-453381 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1001 0722 RS. SANTA CLARA JL. BILITON, NO.15 SUSTER YOSSIE HUMAS0351-

462688/452770/464571|

0351-

455780/466509Y Y Y ACTIVE ALL COVERAGE

[email protected]/pantib

[email protected]

MADURA

1002 0113 RS. LARASATI JL. MANDILARAS, NO.74, PAMEKASAN IBU LISAMARKETING/PEL.M

EDIS0324-328305| 0324-322080 Y Y Y ACTIVE ALL COVERAGE [email protected]

MALANG

1003 0815 RS. PANTI WALUYA SAWAHAN JL. NUSAKAMBANGAN NO.5 IBU RUSMAWATIHUMAS &

MARKETING

0341-

362017,366033,361507|0341-354068 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

1004 0125 RSIA. MELATI HUSADA JL. KAWI, NO.32 IBU YATI MARKETING0341-336271/3413570341-

341357|0341-341357

0341-

365094/341357Y Y Y ACTIVE ALL COVERAGE [email protected]

1005 0708 RS. LAVALETTE JL. W.R. SUPRATMAN, NO.10IBU NUNU

WARDANI/ WINAMARKETING 0341-470805/482612| 0341-470804 Y Y Y ACTIVE ALL COVERAGE [email protected]

1006 4172RSU UNIVERSITAS MUHAMMADIYAH

MALANGJL. TLOGOMAS NO. 45 MALANG LIDYA - 0341 56166| 0341 561627 Y Y Y ACTIVE ALL COVERAGE

[email protected];marketingrs

[email protected]

1007 3611 RSI. MADINAH KASEMBONJL. RAYA SUKOSARI NO. 32 KASEMBON

MALANG

DR

TAUFIKURRAHMAN- 0354-326688/ 393000| 0354-328144 Y Y Y ACTIVE ALL COVERAGE [email protected]

1008 3620 APOTIK KIMIA FARMA 77JL. SUKARJO WIRYOPRANOTO 2K

MALANGMuamar - 0341-365298| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1009 0192 RS. BAPTIS BATUJL. RAYA TLEKUNG NO.1 JUNREJO,

BATU

DRG. SILVIA

DINA/IBU

WIDYA/FRANSISKA/

WIWIN

HUMAS &

MARKETING

0341-5941610341-

598192/5|0341-598192/50341-598911 Y Y Y ACTIVE ALL COVERAGE [email protected]

1010 3437 RSB. MARDI WALOEJA RAMPAL JL. WR. SUPRATMAN NO.01 MALANGINDRA DWI

MISKAWATI- (0341) 364756| - Y Y Y ACTIVE ALL COVERAGE

rsb.mardiwaloeja.rampal@gmail.

com

1011 2967 PERSADA HOSPITALJL. PANJI SUROSO ARAYA BUSINESS

CENTER KAV.II-IV MALANGBPK DIKA/ YOGA - 0341-2996333| 0341-2993773 Y Y Y ACTIVE ALL COVERAGE [email protected]

1012 3814 KIMIA FARMA 453 SUTOYO MALANG JL. LETJEN SUTOYO NO. 107 MALANG - - 0341478382| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 37 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1013 3815 KIMIA FARMA NO.245 BATU

JL. DIPONEGORO NO. 93 BATU

MALANG- - -| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1014 3816 KIMIA FARMA NO. 210 MALANGJL. TUMENGGUNG SURYO NO. 25

MALANG- - 0341423930| - N Y Y PARTIAL

GP,SP,OP,MAT,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1015 3817 KIMIA FARMA NO. 187 MALANG JL. M.T. HARYONO NO. 110 MALANG - - 0341553283| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1016 3818 KIMIA FARMA NO. 150 MALANG JL. SELAT SUNDA 1 D NO. 25 MALANG - - 0341713091| - N Y Y PARTIALGP,SP,OP,MAT,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1017 3820 KIMIA FARMA NO. 36 MALANG JL. IJEN NO. 88 MALANG ANDY ISWANTORO - 0341359677| 341359678 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1018 2048 RS. PRIMA HUSADA MALANGJL. BANJARARUM SELATAN NO. 3,

MONDOROKO SINGOSARI-MALANG

MADE DEWA

SANTIKA

MANAGER

OPERASIONAL0341-458679| 0341-441874 Y Y Y ACTIVE ALL COVERAGE [email protected]

1019 2171 APOTEK FARMARIN MALANGJL. W. R.SUPRATMAN C2 KAV.9

MALANG

YUDI PURNOMO, S.

SI, APTAPOTEKER 0341-334163/4| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1020 2274 KLINIK & APOTEK KF 53 JL. KAWI NO.22 A MALANG ANDY ISWANTONO - 0341 362 301/ 364 056| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1021 2790 RSIA. GALERI CANDRAJL. BUNGA ANDONG NO.3 MALANG

65141

IRMAWATI (081

3335 20478)- (0341) 478571| (0341) 478571 Y Y Y ACTIVE ALL COVERAGE [email protected]

1022 2680 KIMIA FARMA 116 JL. LA SUCIPTO /148,MALANGRATNO SETIAWAN S

FARM- 0341-489539| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1023 2789 RSIA. PURI MALANG JL. TAMAN SLAMET NO.20 MALANG SETIAWATI/IFA UMUM 0341-325329| (0341) 342322 Y Y Y ACTIVE ALL COVERAGE [email protected]

1024 4089 RS. ISLAM GONDANGLEGIJL. HAYAM WURUK NO 66,

GONDANGLEGIWIDI MARKETING 0341 - 879047| - Y Y Y ACTIVE ALL COVERAGE [email protected]

1025 1326 RS. WAVA HUSADA KEPANJENJL. PANGLIMA SUDIRMAN NO.99A

KEPANJENIBU YAYUK MARKETING 0341-393000| 0341-398398 Y Y Y ACTIVE ALL COVERAGE

[email protected];rs

[email protected]

1026 1561 RS. PERMATA BUNDA MALANGJL. SOEKARNO HATTA NO. 75,

LOWOKWARUIBU ICHA MARKETING 0341-487487/407462| 0341-474242 Y Y Y ACTIVE ALL COVERAGE [email protected]

1027 0609 RS. PANTI NIRMALA JL. KEBALEN WETAN, NO.2-8IBU ITA/ DR.

CECILLIAMARKETING 0341-362459| 0341-327930 Y Y Y ACTIVE ALL COVERAGE

[email protected];rahmaemai

[email protected]

1028 1325 RS. MARSUDI WALUYOJL. RAYA MONDOROKO KM.9

SINGOSARIDR. ANITA MARKETING 0341-458974| 0341-451579 Y Y Y ACTIVE ALL COVERAGE

[email protected]

om

1029 1252 RS. ISLAM MALANG ( UNISMA ) JL. MAYJEND HARYONO NO. 139 IBU.IKA MARKETING0341-

551356,580798,565448|0341-551257 Y Y Y ACTIVE ALL COVERAGE [email protected]

1030 0252 RS. ISLAM AISYIYAH MALANG JL. SULAWESI, NO.16 IBU HANNI MARKETING 0341-326773| 0341-368883 Y Y Y ACTIVE ALL COVERAGE [email protected]

1031 1978 RS. MUTIARA BUNDA MALANGJL. CIUJUNG NO 19, MALANG JAWA

TIMURKuswadji MARKETING (0341) 400403; 400722| - Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

1032 1327 RSIA. HUSADA BUNDAJL. PAHLAWAN TRIP NO. 2, ORO-ORO

DOWO

IBU FITRI YUNI

LESTARIHumas/Marketing

(0341) 569634;

566972;569799; 580169|

0341-

580169/569799Y Y Y ACTIVE ALL COVERAGE [email protected]

1033 0094 RSU. HERMINA TANGKUBANPRAHU JL. TANGKUBAN PRAHU, NO.33

IBU ENDROWATI/

IBU JUNIOR

INDRIYANI S.

MARKETING

0341-325082 - 354844 -

354845/460341-

354844/8|0341-354844/8

0341-354843 Y Y Y ACTIVE ALL COVERAGEtangkubanprahu@herminahospit

algroup.com

MOJOKERTO

1034 0785 RS. EMMA JL. RAYA IJEN WATES NO.67 IBU NUR CHOLIPAH MARKETING 0321-328737-|- 0321-334021 Y Y Y ACTIVE ALL [email protected]

/[email protected]

1035 0088 RS. KARTINI MOJOKERTO JL. ERLANGGA, NO.137, MOJOSARI BPK. AGUS MARKETING 0321-592261| 0321-595569 Y Y Y ACTIVE ALL COVERAGE [email protected]

1036 2818 RS. MUTIARA HATIJL. RAYA KEMANTREN WETAN 49,

TERUSAN,GEDEG, MOJOKERTOFATWA AMALIA MARKETING (0321) 7223400, 363442| - Y Y Y ACTIVE ALL COVERAGE

[email protected]/rsmuti

[email protected]

1037 0928 RS. GATOEL MOJOKERTO JL. RADEN WIJAYA NO.56 ZUROTUL AINI MARKETING0321-

321681,322329,399772-|-0321-321684 Y Y Y ACTIVE ALL COVERAGE [email protected]

1038 1980 RS. SIDO WARASJL. RAYA PASAR SAWAHAN KM. 10

BANGSAL KAB. MOJOKERTOIBU EVI MARKETING 0321-598621| 0321-598624 Y Y Y ACTIVE ALL COVERAGE [email protected]

1039 3825 RSI. SAKINAH JL. RA BASUNI NO.12 MOJOKERTO IBU ALFU LAYLA MARKETING 0321-321922| 0321-329670 Y Y Y ACTIVE ALL COVERAGE [email protected]

1040 1997RS. ISLAM HASANAH

MUHAMMADIYAH

JL. HOS. COKROAMINOTO NO.26 - 28,

MAGERS. ARI,MOJOKERTO, JAWA

TIMUR 61313

IBU YATI - 0321-321635| - Y Y Y ACTIVE ALL COVERAGE [email protected]

1041 0164 RS. REKSA WALUYA JL. MOJOPAHIT, NO.422IBU ESTER/ DR.

KRISTANTOMARKETING

0321-322170/3221710321-

322171/3937|0321-

322171/3937

0321-322511 Y Y Y ACTIVE ALL COVERAGE [email protected]

NGAWI

1042 3872 RS. AT-TIN HUSADA JL. RAYA NGAWI-SOLO KM 4 BAPAK NOVIMANAGER

MARKETING0351747888| 351747666 Y Y Y ACTIVE ALL COVERAGE

marketing.rsiattinhusada@gmail.

com

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 38 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALIPACITANPAMEKASAN

1043 3811 APOTEK KIMIA FARMA 274 JL. DIPONEGORO No 4, PAMEKASAN SAFITRI YULIANTI - 0324611332| N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

PASURUAN

1044 3626 KIMIA FARMA 165JL. WAHIDIN SUDIRO HUSODO NO 59

PASURUANSYAIFUL A - 0343-426342| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

PONOROGO

1045 0823 RSU. AISYIYAH PONOROGO JL. DR SUTOMO NO.18-24DR. ENTI / IBU

YUNIKASEKRETARIAT

0352-

481784,461560,485093|0352-484218 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

PROBOLINGGO

1046 4081 RS. RIZANIJL. RAYA SURABAYA SITUBONDO KM

135, KEL SUMBEREJO, KEC PAITONBPK RIDWAN Marketing 0335 773444| - Y Y Y ACTIVE ALL COVERAGE [email protected]

1047 0309 RS. DHARMA HUSADA JL. SOEKARNO HATTA NO.10 BPK. KOKOHUMAS &

MARKETING0335-422176| 0335-422698 Y N Y ACTIVE ALL COVERAGE [email protected]

1048 1330 RSU. WONOLANGAN JL. RAYA DRINGU NO.118DR.H.PRIYATNO/BP.

AFITMARKETING 0335-424007| 0335-431937 Y Y Y ACTIVE ALL COVERAGE [email protected]

SIDOARJO

1049 3839 APOTEK KIMIA FARMA 119 PERUM DELTASARI BLOK AN NO 11 SRI SUPADMI.S.SI - 0318556411| 318556411 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1050 3847 APOTEK KIMIA FARMA 261 JL. MAJAPAHIT NO.35 SIDOARJOVALIANDRI

PUSPANDINI- 0318956674| 318956674 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1051 0545RS. SITI KHODIJAH SEPANJANG

SIDOARJOJL. PAHLAWAN, NO.260, SEPANJANG IBU HANUM KEUANGAN

031-

7881130,7882123,7872081,

60134373|

031-7876066 Y Y Y ACTIVE ALL COVERAGE [email protected]

1052 1108 RSAB. SOERYAJL. RAYA KALIJATEN, NO.11-15, TAMAN

SEPANJANG

BPK.KURNIA

WITJAKSONOMARKETING 031-7885011-|- 031-7873633 Y Y Y ACTIVE ALL COVERAGE [email protected]

1053 3845 APOTEK KIMIA FARMA 180 JL. PAHLAWAN NO.10 SIDOARJODRA.DIAN

NURMAWATI- 0318947116| 318947116 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1054 3857 APOTEK KIMIA FARMA KAHURIPAN JL. KAHURIPAN NO.57 SIDOARJO MARIA AYU S.FARM - 03151517736| 3151517736 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

kimiafarma.kahuripan57@gmail.

com

1055 2273 KLINIK & APOTEK KF 124JL. RAYA SEDATI GEDE NO. 59

SIDOARJOAGUS CAHYANA - 031 867 5751| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1056 2755 RSU. BUNDA SIDOARJOJL. KUNDI NO.70 KEPUH KIRIMAN,

WARU SIDOARJOIBU TUTI Marketing (031) 8668880| (031) 8688218 Y Y Y ACTIVE ALL COVERAGE [email protected]

1057 1336 KLINIK CITRA GADING MEDIKAJL. BRIGJEN KATAMSO BLOK A 408-409

REWIN WARUBPK. SUWAJI KOORDINATOR 031-8679727| 031-8683181 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

om

1058 1339 KLINIK GRAHA MEDICA JL. BRIGJEN KATAMSO NO.7 WARU IBU SULIS HUMAS 031 - 8554910| 031-8554911 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1059 1342 KLINIK MEDIS GELORAPERUM TAMAN PINANG INDAH, BLOK

B7, NO.3-3AIBU IMA MARKETING 031-8929139| 031-8929123 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]/ptgelo

[email protected]

1060 0249 RS. DELTA SURYA JL. PAHLAWAN NO.9 IBU YANNI MARKETING031-8962531-8961271031-

8961271|031-8961271

031-

8961281/8944977Y Y Y ACTIVE ALL COVERAGE

[email protected]/delta-

[email protected]

1061 0927 RS. ANWAR MEDIKA

JL. DUSUN SEMAWUT, RT.10/RW.04,

KEC. BALONGBENDO / JL. RAYA BY

PASS KRIAN KM.33

IBU IKOT/WANTI MARKETING 031-8972052, 8974943-|- 031-8988313 Y Y Y ACTIVE ALL [email protected]/an

[email protected]

1062 0271 RS. ISLAM SITI HAJAR SIDOARJO JL. RADEN PATAH NO.70 BPK REZA MARKETING 031-8921233/8961570|031-

8944438/8944990Y Y Y ACTIVE ALL COVERAGE [email protected]

1063 1040 RS. MITRA KELUARGA WARU JL. RAYA LETJEN. S.PARMAN, NO.8 IBU ELIS MARKETING 031-8543111/8542111-|- 031-8534333 Y Y Y ACTIVE ALL [email protected]/elis.mi

[email protected]

SITUBONDO

1064 3096 RS. ELIZABETH PTP NUSANTARA XI JL. WR SUPRATMAN 2A SITUBONDO DWI AGUS MARKETING 0338-671174| 0338-678061 Y Y Y ACTIVE ALL COVERAGE [email protected]

SURABAYA

1065 0917 RS. WILLIAM BOOTH SURABAYA JL. DIPONEGORO NO.34 IBU PAULINPELAYANAN

ASURANSI031-5678917-|-

031-

5624868,5671380Y Y Y ACTIVE ALL COVERAGE

rs.williamboothsurabaya@yahoo.

co.id

1066 1163 BRAIN CLINIC JL. SULAWESI, NO.63 DRG.MELANY - 031-5018800/031-5038004| - N Y Y ACTIVE ALL COVERAGE -

1067 0980 RS. ISLAM SURABAYA JL. JEND A YANI NO.2-4 IBU LOVA/BPK BUDI MARKETING 031-8284505-|- 031-8291805 Y Y Y ACTIVE ALL COVERAGE [email protected]

1068 3837 APOTEK KIMIA FARMA 52 JL. DUKUH KUPANG NO.54 DRS. SURYADI,APT - 0315671773| 315665755 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 39 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1069 3843 APOTEK KIMIA FARMA 166 JL. A.YANI 228 SURABAYA

DRA.RENY

BESYANITA- 0318291785| 318291785 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1070 3844 APOTEK KIMIA FARMA 175JL. KARANG MENJANGAN NO.9

SURABAYAAYU IRAWATI - 0315991991| 315991991 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1071 3846 APOTEK KIMIA FARMA 243 JL. RAYA ARJUNO NO.151 SURABAYA SARI RAKHMAWATI - 0315345031| 315459789 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1072 0809 RS. SPESIALIS HUSADA UTAMA JL. PROF DR MOESTOPO 31-35IBU TATIK DYAH

WULANDARIMARKETING

031-

5017975/5018335(021)

9100682|(021) 9100682

031-5018337 Y Y Y ACTIVE ALL [email protected];

[email protected]

1073 3848 APOTEK KIMIA FARMA 304 JL. PERAK TIMUR NO.166 SURABAYA IRMA NURYANTIE - 0313550007| 313550007 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1074 3850 APOTEK KIMIA FARMA 407 JL. MULYOSARI NO.288 SURABAYA HANS ALARKIE - 0315937994| 315937994 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

onestophealtcaremulyasari@gma

il.com

1075 2001 RS. WIYUNG SEJAHTERAJL. KARANGAN PDAM NO.1-3 WIYUNG

SURABAYAIBU SURIYAH MARKETING (031) 7532653| (031) 7533726 Y Y Y ACTIVE ALL COVERAGE [email protected]

1076 0830 RS. ADI HUSADA UNDAAN WETANJL. UNDAAN WETAN NO40-44

SURABAYADR.ANANG PITOYO

KOORDINATOR

MARKETIN

031-5321256031-

5318000|031-5318000031- 5321081 Y Y Y ACTIVE ALL COVERAGE

[email protected]

om

1077 2272 APOTEK KIMIA FARMA 35JL. NGAGEL JAYA SELATAN NO. 107

SURABAYA 60258AGUS CAHYANA - 031 504 1276, 504 9098| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1078 2212 APOTEK FARMARIN SURABAYA JL. JEMUR ANDAYANI II/1, SURABAYASETIA.N, S.FARM,

APT- 031-8418190| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1079 2217 RS. KENDANG SARI SURABAYAJL. RAYA KENDANGSARI NO.38

SURABAYAIBU DINI marketing 031-8436200/8437200| 031-8494484 Y Y Y ACTIVE ALL COVERAGE [email protected]

1080 2315 NATIONAL HOSPITAL SURABAYABOULEVARD FAMILI SEL KAV 1 GRAHA

FAMILI, SURABAYA

IBU.LULU / IBU.MEI

MUNAWAHDivisi Marketing 031-2975777| 031-297799 Y Y Y ACTIVE ALL COVERAGE [email protected]

1081 2476 RS. ROYAL SURABAYA JL. RUNGKUT INDUSTRI I/ 1 SURABAYA SANDRA RAHESTI - 031-8476111| 031-8476211 Y Y Y ACTIVE ALL COVERAGE [email protected]

1082 2785RS. ORTHOPEDI DAN

TRAUMATOLOGY

JL. EMERALD MANSION TX 10

CITRALAND, SURABAYA

DR. KARINA

DARMANTOMARKETING (031) 57431299| (031) 57431255 Y Y Y ACTIVE ALL COVERAGE

[email protected]

om

1083 2786 RS. PURA RAHARJA JL. PUNCANG ADI 12-14 SURABAYA IBU ERNA RISMA -(031) 5019898/ 5022151/

5024591|- Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

1084 1362 RS. BHAKTI RAHAYU SURABAYA JL. KETINTANG MADYA I/16 IBU ASMANI MARKETING

031-

8295922/8291799/8299217

/23|

031-8293839 Y Y Y ACTIVE ALL COVERAGE -

1085 1363 RS. BUNDA SURABAYAJL. RAYA KANDANGAN NO.23-24

BENOWOBPK.AFIT MARKETING

031 -

7442220/7440077/7400694

|

031 - 7442133 Y Y Y ACTIVE ALL COVERAGE [email protected]

1086 1365 RS. MATA UNDAAN JL. UNDAAN KULON, NO.19 BPK ARNOLD Marketing 031-5343806/531619| 031-5317503 Y Y Y ACTIVE ALL COVERAGEmarketing.rsmataundaan@gmail

.com

1087 1453 RS. ONKOLOGIARAYA GALAXI BUMI PERMAI BLOK

A2/7 JL. ARIEF RAHMAN HAKIM 182BP. BUDIONO MARKETING 031-5914855| 031-5914860 Y Y Y ACTIVE ALL COVERAGE [email protected]

1088 1454RSIA. PUTRI ( RS. KHUSUS

OBSTETRI & GINEKOLOGI )JL. ARIF RAHMAN HAKIM, NO.122

IBU

LESTARI/BPK.HARRY

SEKRETARIS

DIREKTUR031-5999987| 031-5997215 Y Y Y ACTIVE ALL COVERAGE [email protected]

1089 1201 RS. ADI HUSADA KAPASARI JL. KAPASARI NO.97-101 DR.DANI, IBU PIPIN MARKETING 031-3764555| 031-3764666 Y Y Y ACTIVE ALL COVERAGE [email protected]

1090 1690 RS. BEDAH SURABAYA JL. RAYA MANYAR NO 9 SURABAYA IBU DWIKA/ TIAS MARKETING 031-5999369,5999339| 031-5995284 Y Y Y ACTIVE ALL COVERAGErumahsakitbedahsurabaya@gma

il.com

1091 1364 RS. ISLAM SURABAYA JEMURSARI JL. JEMURSARI NO.51-57BPK DICKY, IBU

FARIDAMARKETING

031 -

8471877/8471878/8471889

|

031-8437784 Y Y Y ACTIVE ALL [email protected]/faridar

[email protected]

1092 0136 RS. MITRA KELUARGA SURABAYA JL. SATELIT INDAH II, DARMO SATELIT IBU SELLY MARKETING 031-7345333| 031-7345955 Y Y Y ACTIVE ALL [email protected]

/[email protected]

1093 0163 RS. DARMO JL. RAYA DARMO, NO.90IBU LARASATI/ BP

MITRAMARKETING 031 - 567 6253/54/55/56| 031-5620690 Y Y Y ACTIVE ALL COVERAGE [email protected]

1094 0544RS. ST.VINCENTIUS A.PAULO (RS.

RKZ)JL. DIPONEGORO NO.51 IBU VIDYA MARKETING

031-

5677562,5687846,5663895

031-5687846|031-5687846

031-

5674748/5651057Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

1095 0895RS. PRIMASATYA HUSADA CITRA (

PHC )

JL. PRAPAT KURUNG SELATAN NO.1

TANJUNG PERAKBPK.NORWENDO MARKETING 031-3294801-3-|- 031-3294804 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

1096 0896 KLINIK KEBRAON JL. GRIYA KEBRAON BLOK FA NO.37 BPK HARI SANTOSO PENGELOLA 031-7663816-|- 031-7663816 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

1097 0897 KLINIK BENOWO PONDOK BENOWO INDAH, BLOK PP/22 DR. SHELLA KOORDINATOR 031-70547492-|- - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1098 0081 SILOAM HOSPITALS SURABAYA JL. RAYA GUBENG NO. 70, SURABAYA IBU ADI/ IBU YUNI MARKETING 031-5031333/5031821|031-

5031533/5039313Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 40 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1099 2925 RS. MITRA KELUARGA KENJERAN JL. KENJERAN 506 SURABAYA 60114 DEWI MUNAWAROH Marketing (031) 99000880| (031) 99000885 Y Y Y ACTIVE ALL [email protected]

m

1100 3851 APOTEK KIMIA FARMA 432 PANDUGO JL. PANDUGO MERR NO.2 SURABAYAWIRA

KUSUMA.S.FARM- 0318709962| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1101 3852 APOTEK KIMIA FARMA G-WALKRUKO TAMAN GAPURO B.2, G-WALK

SURABAYA

FENITASARII.S.FAR

M- 0317411121| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1102 3853 APOTEK KIMIA FARMA WIYUNGRUKO TPI BLOK A 17 RAYA MEGANTI

SURABAYA

DERRY

SUSANTI.S.FARM- 0317668267| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1103 3855 APOTEK KIMIA FARMA CILIWUNG JL. CILIWUNG NO.76 SURABAYATINJUNG

DESMARANTI- 0315633156| 315633156 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1104 3856 APOTEK KIMIA FARMA KLAMPISJL. KLAMPIS JAYA BLOK A NO.30

SURABAYA

KURNIA PUSPITA

NINGRUM- 0315926293| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1105 3858 APOTEK KIMIA FARMA RUNGKUT JL. RUNGKUT MADYA NO.97 SURABAYAKHOLIFATUS

SADIYAH.S.FARM- 0318721059| 318721059 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1106 3197 RS. SURABAYA MEDICAL SERVICE JL. KAPUAS NO. 2 SURABAYA BPK ANANG - 031-5686161| - Y Y Y ACTIVE ALL COVERAGE [email protected]

1107 3002 LAB. KLINIK BIOTEST SURABAYAJL. RA. KARTINI NO.78, SURABAYA,

JAWA TIMUR

IBU RICI

(08122316492)MARKETING (031) 5673498| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1108 3390RSIA. LOMBOK DUA DUA ( JL.

FLORES)JL. FLORES NO. 12 SURABAYA RESTI / RATNA

Markting /

Keuangan031- 5022044| - Y Y Y ACTIVE ALL COVERAGE [email protected]

1109 0829RS. PREMIER SURABAYA (RS.

SURABAYA INTERNASIONAL)JL. NGINDEN INTAN BARAT, BLOK B

BPK WIDODO/ IBU

IRAMARKETING 031- 5993211|031-5993211 031- 5993214 Y Y Y ACTIVE ALL COVERAGE

rspremier.surabaya@ramsayheal

th.co.id

1110 4209 RS. WIJAYA SURABAYA JL. MENGANTI 398 WIYUNG SURABAYA PAK BOBBY - 031-7523087/031-7523282| Y Y Y ACTIVE ALL [email protected];

[email protected]

1111 3831 APOTEK KIMIA FARMA 22 JL. BRATANG GEDE NO.100 A SurabayaDRS. HERU

SUMEHORO- 0315016713| 315016713 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1112 3832 APOTEK KIMIA FARMA 23 JL. KENDANGSARI BLOK J NO.7 DRS. ARI WAHYUDI - 0318414215| 318419345 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1113 3833 APOTEK KIMIA FARMA 24 JL. DHARMAWANGSA NO.24DRS. AKHMAD

YANI,APT- 0315032775| 315037664 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1114 3834 APOTEK KIMIA FARMA 25 JL. RAYA DARMO NO.2-4ACHMAD

MUJIANTORO- 0315677777| 315666454 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1115 3835 APOTEK KIMIA FARMA 26 JL. DIPONEGORO NO.94DRS. NONO

SUMARNO- 0315677007| 315664420 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1116 3836 APOTEK KIMIA FARMA 45 JL. RAYA DARMO NO.94DRS. HERI

SUMANTO- 0315676301| 315678819 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

TUBAN

1117 1198 RS. MEDIKA MULIA TUBAN JL. MOJOPAHIT, NO.699 TUBAN BPK.EKO MARKETING 0356-322744/324618| 0356-322666 Y Y Y ACTIVE ALL COVERAGE [email protected]

1118 2002 RS. NAHDATUL ULAMA TUBAN JL. LETDA SUCIPTO NO 211 TUBAN

IBU

MARTIANAWATI,M.K

ES

MARKETING0356-328244/(0356)

328299|(0356) 712072 Y Y Y ACTIVE ALL COVERAGE [email protected]

TULUNG AGUNG1118 0813 RS. ISLAM ORPEHA JL. KH. R. ABDUL FATAH IBU WIDI KASI- PERAWAT 0355-323186| 0355-327691 Y Y Y ACTIVE ALL COVERAGE [email protected]

1119 3826 RS. ERA MEDIKAJL. RAYA PULOSARI, NGUNUT,

TULUNGAGUNG, JAWA TIMUR

IBU VICA

DESTRIANAMARKETING

0355-398706/396566/

08155199111|0355-398706 Y Y Y ACTIVE ALL COVERAGE

[email protected]/d_que

[email protected]

1120 3708 APOTEK KIMIA FARMA 392JL. I GUSTI NGURAH RAI NO. 10

TULUNGAGUNGBP. PUJI SANTOSO SPV PELAYANAN 0355-322308| 0355-322308 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

KETAPANG

1121 1800 RS. FATIMA KETAPANG JL. JEND SUDIRMAN NO. 27 KETAPANG DR INDAH - 0534-32814| 0534-31649 Y Y Y ACTIVE ALL COVERAGE -

PONTIANAK

1122 2729 RS. MITRA MEDIKA PONTIANAKJL. SULTAN ABDURRAHMAN NO.25,

PONTIANAK, KALBAR

IRMINA

(081345274813)- (0561) 584888| - Y Y Y ACTIVE ALL COVERAGE [email protected]

1123 1106 RS. SANTO ANTONIUS JL. KH. WAHID HASYIM NO.249IBU LENA/ BP

VIEDNOMarketing 0561-732101-|-

0561-

742242/733623Y Y Y ACTIVE ALL COVERAGE [email protected]

1124 1431RSIA. ANUGERAH BUNDA

KHATULISTIWAJL. AHMAD YANI NO. 5-7

NOVI INDRAWAN,

IBU YUNI,MARKETING 0561-581818| 0561-584100 Y Y Y ACTIVE ALL COVERAGE

[email protected]:

[email protected]

1125 1036 RS. KHARITAS BHAKTI JL. SIAM, NO.153 PONTIANAK IBU AFI MARKETING 0561-734373-|- 0561-768969 Y Y Y ACTIVE ALL COVERAGE [email protected]

1126 2679 KIMIA FARMA SEI RAYAJL. SEI RAYA DALAM,RUKO B1,

PONTIANAK

DRS. NISAMUDDIN,

APT- 0567-737797| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

KALIMANTAN BARAT

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 41 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1127 2253 KLINIK & APOTEK KF 32 PONTIANAK

JL. TANJUNG PURA NO. 419,

PONTIANAKBPK TIGOR - 0561-731658| 0591-735802 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1128 2254APOTEK KIMIA FARMA 371

PONTIANAKJL. AHMAD YANI NO. 5, PONTIANAK BP FALAH - 0561-713988| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1129 2255 KIMIA FARMA 333 PONTIANAKJL. WAHID HASYIM NO. 60,

PONTIANAKIBU METI - 0561-768140| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

SINGKAWANG

1130 2621 RSU. HARAPAN BERSAMAJL. N. P. BELITUNG NO. 61)

SINGKAWANG

IBU SUSI/IBU

AYU/IBU WIWIN- 0562-631791| 0562-633359 Y Y Y ACTIVE ALL COVERAGE [email protected]

1131 1368RS. SANTO VINCENTIUS

SINGKAWANGJL. P. DIPONEGORO NO.5

IBU

MAEMUNAH/KRISTI

N/DR. MELDA

MARKETING 0562-631008| 0562-633881 Y Y Y ACTIVE ALL COVERAGE [email protected]

BANJARMASIN

1132 2237 KIMIA FARMA 188JL. LETJEN S. PARMAN NO. 42

BANJARMASINIBU MARLINI - 0511-3354020| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1133 2235 KLINIK & APOTEK KF NO.61 JL. VETERAN NO. 51 BANJARMASIN BPK BAHRUDIN APOTEKER 0511-3250682/3252779| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1134 2236 APOTEK KIMIA FARMA 217JL. A. YANI KM 2 NO. 136

BANJARMASINBPK. HIDAYAT APOTEKER 0511-3252250/3251369| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1135 0763 RS. SUAKA INSAN JL. H.ZAHRI ZAMZAM NO.60

IBU

HILDA/SUS.FLORDE

RISA

HUMAS/TATAUSAH

A0511-3356280/81| 0511- 55122 Y Y Y ACTIVE ALL COVERAGE [email protected]

1136 0631 RS. SARI MULIA JL. PANGERAN ANTASARI NO. 139B IBU ADIT/BPK.APRI MARKETING

0511 -

3274447/3261491/3252570

0511-266960|0511-266960

0511 - 3257889 Y Y Y ACTIVE ALL [email protected];

[email protected]

1137 0849 RS. ISLAM BANJARMASINJL. LET JEN S PARMAN GG.PURNAMA

NO.1 BANJARMASIN

IBU NURUL/ BPK

GUSTIHUMAS

0511-3350332, 3354896,

3350335|0511-3350332/350511-3351690 Y Y Y ACTIVE ALL COVERAGE [email protected]

1138 1758 KLINIK SPESIALIS SARI MULIA JL. PANGERAN ANTASARI NO. 139 B BP APRI KEUANGAN

0511-

3254341/3266960/3252570

|

0511-3266960 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

KANDANGAN

1139 1799 RS. PAHLAWAN MEDIKA CENTERJL. PAHLAWAN NO. 15 KANDANGAN

KAB. HULU SUNGAI SELATANIBU FUJI MARKETING 0517-23191| 0517-23678 Y Y Y ACTIVE ALL COVERAGE [email protected]

MARTAPURA

1140 1797 RSIA. MUTIARA BUNDA MARTAPURA JL. TAISIR NO. 2, MARTAPURAANDRI TRI

CAHYONOMARKETING O511- 4721901| 0511- 4720664 Y Y Y ACTIVE ALL COVERAGE [email protected]

1141 2721 RS. PELITA INSANIJL. SEKUMPUL NO.66 MARTAPURA

70614, KALIMANTAN SELATANINDRA ATMAJA MARKETING (0511) 4722210, 4722220| (0511) 4722230 Y Y Y ACTIVE ALL COVERAGE [email protected]

TABALONG

1142 2707 RS. PERTAMINA TANJUNG

JL. GAS, KOMPERTA MURUNG PUDAK

TANJUNG, KALIMANTAN SELATAN

71571

IBU RITA/ DR

RAHMAWATIWadir (0526) 2022550/2023068| (0526) 2027678 Y Y Y ACTIVE ALL COVERAGE -

TANAH BUMBU

1143 1011 KLINIK SURYA MEDIKA SATUI (SMS)JL. PROPINSI NO 11, RT 17 SUNGAI

DANAU SATUIDR ZAINAL DIRETUR 0512-61717|0778-322122 0512-61312 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

o.id

1144 3996 KLINIK SIMPANG TANAH BUMBU

JL. GAWE SABUMI RT 08 NO. 083,

DESA BERSU. JUD,KEC. SIMPANG

EMPAT, KAB. TANAH BUMBU,

KALIMANTAN SELATAN 72200

DR DINA -(081258339911 /

081953230699)|- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1145 2471 KLINIK MEDIKA BATULICIN

JL. RAYA BATULICIN - SERONGGO KM.

1 SEI KECIL, BATULICIN, TANAH

BAMBU - KALSEL

- - 0518-71570| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

PALANGKARAYA

1146 2889RS. ISLAM PKU MUHAMMADIYAH

PALANGKARAYA

JL. RTA MILONO KM .2,5 MENTENG,

JEKAN RAYA PALANGKARAYA

ALFIAN

FADILLAH/SRI

ROKAYAH

MARKETING 0536-3244801/3239444| 5363244802 Y Y Y ACTIVE ALL COVERAGE [email protected]

1147 1377 RSUD DR. DORIS SYLVANUS JL. TAMBUN BUNGAI NO.4IBU RUSBINI / IBU

INA UDIATIMarketing 0536-3224217| 0536-3229194 Y Y Y ACTIVE ALL COVERAGE [email protected]

PANGKALAN BUN

1148 3529 KLINIK KESUMAJL. ISKANDAR NO. 12 A, PANGKALAN

BUN, KALIMANTAN TENGAHOSCAR VIYARISA MARKETING (0532) 23935| (0532) 23935 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

KALIMANTAN SELATAN

KALIMANTAN TENGAH

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 42 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALISAMPIT

1149 4085 KLINIK SARI MEDIKA SAMPIT JL. P.ANATASARI NO 5 SAMPITDR. YULIA / IBU

MIRNA053125288| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

BALIKPAPAN

1150 1520 APOTEK KIMIA FARMA 56 JL. A.YANI, NO.95 BPK. SUBEKTI - 0542-424187,7031852| 0542-731560 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1151 3459 SUMATERA EYE CENTRE BALIKPAPANRUKO SENTRA EROPA BLOK AA 2B

NO.16 BALIKPAPAN BARUBP.ULLISYS koordinator (0542) 876732/876941| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

smec_balikpapan@smec-

group.com/[email protected]

1152 0686 PANACEA CLINICKOMP MAL FANTASI BLOK AB2 NO.18-

20 BALIKPAPAN BARU 76114IBU Maya KOORDINATOR

0542-877898,72040460751-

444712/5|0751-444712/5

0542-

877641/7031819N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected].

id

1153 0692 APOTIK KANIDA FARMA II JL. JEND. SUDIRMAN, NO. 239 IBU RINI MARKETING0542-424309,0542

420496|0542-4204960542-424031 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1154 0633 RS. PERTAMINA BALIKPAPAN JL. JEND SUDIRMAN NO.1 IBU REISA DELSIA MARKETING 0542-7517485/734020/21| 0542-7517493 Y Y Y ACTIVE ALL [email protected];custom

[email protected]

1155 1213 RS. BALIKPAPAN BARUKOMP. BALIKPAPAN BARU JL.

MT.HARYONO BLOK. A-A3

IBU

GANIS/BPK.YANTOSEKRETARIS 0542-877330| 0542-877331 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

1156 0672 RSIA. PERMATA HATI BALIKPAPAN JL. IMAM BONJOL NO.1IBU NENENG/IBU

HAPSARIKEUANGAN 0542-413932/413928| 0542 - 413928 Y Y Y ACTIVE ALL COVERAGE

hapsari.dewi@rs-

permatahati.com

1157 0632 RS. RESTU IBU JL. JEND. A. YANI, NO.12 BP RURY MARKETING0542-427342/3/40542-

427342|0542-427342

0542-

441494/417290Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

1158 2635 KLINIK & APOTEK KF 329 JL. SOEKARNO HATTA KM 5 / 86, BPNERMANSYAH

SIREGAR.S.SI.,APT- 0542 860024| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1159 2634 KLINIK & APOTEK KF SEPINGGAN JL. MARS. MA ISWAHYUDI NO. 72

APRILYANI

KUSUMAWATI,S.FAR

M.,APT

- 0542 7310391| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1160 2633 KLINIK & APOTEK KF 68JL. JEND.SUDIRMAN NO.2-3

PERTOKOAN KLANDASAN

ANGGA TRI

SAPTA.S.FARM.,APT- 0542 422691| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1161 2632 KLINIK & APOTEK KF 293 JL. A. YANI NO.45 KARANG JATI

AANG

ROYYANA.S.FARM.,A

PT

- 0542 413090| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1162 1457KLINIK & APOTEK KF 136

BALIKPAPANJL. MT. HARYONO NO. 72 BPK.WINASTANTO KOORDINATOR 0542-763962| 0542-761629 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1163 1374SILOAM HOSPITALS BALIKPAPAN (RS

BALIKPAPAN HUSADA)

JL. MT.HARYONO NO.9 RINGROAD,

BALIKPAPAN - KALIMANTAN TIMUR

DR.BAYU

A/ISWANDI KMARKETING 0542 - 8862 999| 0542-7206517 Y Y Y ACTIVE ALL COVERAGE [email protected]

1164 2073KLINIK MEDIKA UTAMA ( KMU

SETIARA )

JL. MULAWARMAN NO. 24 RT 7

MANGGAR BARU BALIKPAPAN,

KALIMANTAN TIMUR

CAHYA AYU - 0542-770846| 0542-770847 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

[email protected]

BONTANG

1165 2118 RS. AMALIA BONTANGJL. R. SOEPRAPTO NO. 22 BONTANG

BARU, KOTA BONTANG KALTIMBPK CHA HRD 0548-25050| 0548-23275 Y Y Y ACTIVE ALL COVERAGE [email protected]

1166 2474 KLINIK RS. PKT 1 JL. IMAM BONJOL BONTANG-KALTIM - - 0548-24800| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1167 1214 RS. PUPUK KALTIM BONTANGJL. OKSIGEN NO.1, KOMP.PUPUK

KALTIMBPK.SAHARUDIN MARKETING 0548-41118/41444| 0548-41555 Y Y Y ACTIVE ALL COVERAGE

[email protected]/suko_rs@yah

oo.co.id

KUTAI KARTANEGARA

1168 1074 KLINIK MAJU SEJAHTERAJL. MOH. HATTA, HANDIL 3, MUARA

JAWAIBU INDRI/ ELIN MANAGER KLINIK

0541-691891/

081333001836-|-0541-691892 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

SAMARINDA

1169 3813 KLINIK & APOTEK KF 385 (PPO) JL. P.M.NOOR SAMARINDA ERISKA - 0541-220286| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1170 3460 SUMATERA EYE CENTRE SAMARINDA JL. A. YANI NO. 6 A-B SAMARINDA BP.BOY ANDRIAN Koordinator (0541) 200257, 200258| - Y Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

smec_samarinda@smec-

group.com/[email protected]

m

1171 0636 RS. DIRGAHAYU JL. GN. MERB. ABU, NO. 62IBU MARDALENA/

IBU VEROKEPALA HUMAS

0541-

742161/748309/748310054

1-748309/10/11|0541-

748309/10/11

0541-

748308/744636Y Y Y ACTIVE ALL COVERAGE [email protected]

1172 1794 RSIA. THAHA BAKRIEJL. PANGERAN HIDAYATULLAH NO 11

SAMARINDAIBU FANI MARKETING 0541-742191| 0541-200075 Y Y Y ACTIVE ALL COVERAGE [email protected]

1173 1656 KLINIK MELATI HUSADA

JL. CIPTO MANGUN KUSUMO RT 12 NO

52 KEL SENGKOTEK LOA JUAN

SAMARINDA

DR HALIDA PEMILIK 0541-260721| 0541-241752 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

KALIMANTAN TIMUR

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 43 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1174 2104 KLINIK & APOTEK KF 105 JL. DR. SUTOMO NO 36-37 SAMARINDA SUTARNO APOTEKER -| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1175 2105 KLINIK & APOTEK KF 138 KARTIKAJL. KH AGUS SALIM NO. 30

SAMARINDA 75121

BPK. AHMAD ANDI

RIVAIAPOTEKER 0541-737447| N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1176 0635 RS. ISLAM SAMARINDA JL. GURAMI, NO.18 IBU JURIANTI MARKETING 0541 - 741510/731857| 0541 - 731856 Y Y Y ACTIVE ALL COVERAGE [email protected]

1177 2473 RS. SIAGA RAMANIAJL. RAMANIA 3 ( JL. JEND. SOEPARTO)

SAMARINDA, KALTIMBAPAK PION Penagihan 0541-739772| 0541-749131 Y Y Y ACTIVE ALL COVERAGE [email protected]

1178 2631 KIMIA FARMA 114JL. P.HIDAYATULLAH NO.63,

SAMARINDA

DRS. FAHARUDDIN,

APT- 0541 742198| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1179 2453 RS. SAMARINDA MEDIKA CITRAJL. KADRIE OENING NO.81 RT.35

SAMARINDA 75124ELMI YANTI MARKETING (0541) 7273000| (0541) 7272888 Y Y Y ACTIVE ALL COVERAGE [email protected]

1180 0230 RS. H. DARJAD JL. DAHLIA, NO.4 BPK HUDI/IBU LULU MARKETING0541-

732698,734123,732609|0541-732562 Y Y Y ACTIVE ALL COVERAGE [email protected];

SANGATTA

1181 1376RS. PKT PRIMA SANGATTA (RS.

PUPUK KALTIM )

JL. YOS SUDARS. O I NO.1 SANGATTA -

KALIMANTAN TIMURBPK RAHMAT SDM 054924555|

0549-24524;

25927Y Y Y ACTIVE ALL COVERAGE

[email protected]/prima@rspkt

.com

1182 3579 RS. PERTAMEDIKA AULIA SANGATTAJL. KARYA ETAM RT. 14 NO. 79,

SANGATTA 75611VICA WIJAYANTI MARKETING (0549) 2029456|

(0549)

2029404/20294Y Y Y ACTIVE ALL COVERAGE [email protected]

1183 1556 RS. MELOY SANGATTAJL. YOS SUDARS. O II NO.101

SANGATTA - KALIMANTAN TIMURBPK HARYUDI - 0549-2026258| 0549-24222 Y N Y ACTIVE ALL COVERAGE [email protected]

TARAKAN1182 1972 RUMKITAL ILYAS TARAKAN JL. MARTADINATA NO 29 - - 0551-24320 / 21353| - Y Y Y ACTIVE ALL COVERAGE -

1183 1529 RS. PERTAMINA TARAKAN JL. MULAWARMAN NO. 14, TARAKAN IBU HASNAMARKETING DAN

HUMAS0551-31403/31665| 0551-33310 Y Y Y ACTIVE ALL COVERAGE

[email protected];zu

[email protected]

BANDAR LAMPUNG

1184 0487 RS. ADVENT LAMPUNGJL. TEUKU UMAR, NO.48 KEDATON

BANDAR LAMPUNGBPK OTOT MARKETING 0721-703459|

0721-

786349/770717Y Y Y ACTIVE ALL COVERAGE [email protected]

1185 0486 RS. IMMANUEL WAY HALIM JL. SOEKARNO-HATTA, WAY HALIM IBU NOVI/IBU RINA Pelayanan Asuransi 0721-704900,704630/628|0721-

704807/784897Y Y Y ACTIVE ALL COVERAGE

[email protected]/rs_im

[email protected]

1186 1092 RS. MITRA HUSADA PRINGSEWUJL. JEND A. YANI NO.14 PRINGSEWU,

LAMPUNG

IBU SRI HARTATI /

IBU SERI

MARKETING EXT

1010729-23792-|- 0729-23836 Y Y Y ACTIVE ALL COVERAGE [email protected]

1187 1378 RS. URIP SUMOHARJOJL. URIP SUMOHARJO NO.200

SUKARAME

IBU

IDA/BP.BAMBANG

PELAYANAN

ASURANSI0721-771322/23/24|

0721-

771321/707990Y Y Y ACTIVE ALL COVERAGE [email protected]

1188 1313 RS. MARDI WALUYOJL. JEND SUDIRMAN NO 156 KOTA

METRO 34111 BD LAMPUNGBPK. YANTO Marketing 0725-42512/44980| 0725-7850499 Y Y Y ACTIVE ALL COVERAGE [email protected]

1189 1228 RS. BUMI WARAS JL. WOLTER MONGINSIDI, NO.235DR. ARIEF/ IBU

HESTIMarketing

0721-

254589/261122/257925/26

7855|

0721-257926 Y Y Y ACTIVE ALL [email protected];

[email protected]

1190 1692 RS. HARAPAN BUNDA LAMPUNGJL. RAYA LINTAS SUMATERA NO.30

SEPUTIH JAYA LAMPUNG TENGAHIBU ARI MARKETING 0725-26766| 0725-25091 Y Y Y ACTIVE ALL COVERAGE

[email protected]/aridaniasri

@rshb-lampung.co.id

1191 1693 RSIA. MUTIARA PUTRIJL. HOS COKROAMINOTO NO 76

ENGGAL LAMPUNGBPK LUTFI MARKETING 0721-252579/254999| 0721-254282 Y Y Y ACTIVE ALL COVERAGE [email protected]

1192 1699 RSB. ANUGERAH MEDIKAJL. KAPTEN ACHMAD IBRAHIM NO.

21/23 ENGGALBPK.GANJAR - 0721-240488/262310| Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

1193 1632 RS. NATAR MEDIKA (YADIKA GROUP)JL. RAYA NATAR NO. 04 MUARA PUTIH,

KEC NATAR LAMPUNG SELATANAYU WANDIRA MARKETING 0721-92521/92519| 0721-92519 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

1194 1871 RS. PERTAMINA BINTANG AMIN JL. PRAMUKA NO 27, LAMPUNG BP FITER ROMILADO-- 0721-273601| 0721-273597 Y Y Y ACTIVE ALL COVERAGE [email protected]

1195 1352 RS. GRAHA HUSADA LAMPUNGJL. GAJAH MADA, NO. 6 GH, TANJUNG

AGUNG, BANDAR LAMPUNGIBU SHANTY S. HUMAS 0721-240000|

0721-

263181/268417Y Y Y ACTIVE ALL COVERAGE [email protected]

1196 1970 RSIA. BUNDA AS-SYIFAJL. DR.SUSILO NO. 54 PAHOMAN TELUK

BETUNG UTARA BANDAR LAMPUNGBAPAK ERI MARKETING

0721-

240474/259259/256256|0721-266800 Y Y Y ACTIVE ALL COVERAGE

[email protected]/wildi

[email protected]

1197 2110KLINIK & APOTEK KF 131 BANDAR

LAMPUNG

JL. KARTINI NO. 44-45 BANDAR

LAMPUNG- - -| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1198 2112KLINIK & APOTEK KF 327 BANDAR

LAMPUNG

JL. JEND. SUDIRMAN NO. 88 BANDAR

LAMPUNGPak Yacub Apoteker 0721- 5600608| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1199 2176 RSIA. RESTU BUNDAJL. K.H. HASYIM ASHARI NO. 73, TELUK

BETUNG SELATAN - BANDAR LAMPUNGIBU ANNA MARKETING 0721-484158/484185| 0721-482832 Y Y Y ACTIVE ALL COVERAGE [email protected]

1200 2465 RSIA. PURI BETIK HATIJL. PAJAJARAN NO.109, JAGABAYA,

BANDAR LAMPUNG, LAMPUNGBPK.ADHI WIJAYA - 0721-787799| - Y Y Y ACTIVE ALL COVERAGE [email protected]

1201 2767 RS. ISLAM ASY-SYIFAA

JL. NEGARA LINTAS SUMATERA KM.65

YUKUM JAYA - BANDAR JAYA, KEC.

TERB. ANGGI BESAR, LAMPUNG

TENGAH 34162

BAPAK BOWO - (0725) 25264| (0752) 527476 Y Y Y ACTIVE ALL COVERAGE [email protected]

KALIMANTAN UTARA

LAMPUNG

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 44 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1202 0762 RS. YUKKUM MEDICAL CENTERJL. NEGARA NO 99, KM 67 YUKUM

JAYA, LAMPUNG TENGAHIBU NUR JUAMI MARKETING 0725-25333| 0725 - 25989 Y Y Y ACTIVE ALL COVERAGE [email protected]

LAMPUNG SELATAN

1203 3170 KLINIK DUA PUTRI JAYA

JL. IR. SUTAMI KM.30 DESA MALANG

SARI, TANJUNG SARI-LAMPUNNG

SELATAN

IBU PUTRI PIMPINAN 085366797190| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

AMBON

1204 2911 RS. T TK.II DR.J.A. LATUMETEN JL. DR. TAMAELA N0. 2 AMBON KAPTEN AANGBag.

Pengembangan0911-353555| 0911-354763 Y Y Y ACTIVE ALL COVERAGE [email protected]

1205 1439 RS. BHAKTI RAHAYU AMBON JL. BATU KERB. AU, BELAKANG RRI WELFRA ANDRIE MARKETING 0911-342746| - Y Y Y ACTIVE ALL COVERAGE -

1206 2265APOTEK KIMIA FARMA PEL.26

AMBON,MALUKU

JL. DR. KAYADOE, KEL. KUDAMATI,

AMBON-MALUKU(DI DALAM RS.

HALAUSSY)

BPK LUKAS - 0911-351677| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1207 2912 RS. SUMBER HIDUPJL. ANTHONY RHEBOK, HONIPOPU,

SIRIMAU, AMBON, MALUKUGRACE Marketing (0911) 352373, 351654| 0911-352401 Y N Y ACTIVE ALL COVERAGE [email protected]

TERNATE

1208 2260KLINIK & APOTEK KF 168 TAKOMA

TERNATE

JL. HASAN ESA 151 TERNATE, MALUKU

UTARABP TRI KURNIAWAN BM 0921-3121037/3123076| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1209 2012 RS. ISLAM TERNATE JL. PEMUDA NO. 131 KEL.TOBELEUIBU TUTI/IBU

RUGAYA

TATA

USAHA/HUMAS0921-3121623| - Y Y Y ACTIVE ALL COVERAGE [email protected]

1210 1503 RS. MEDIKA HARIFALMJL. ZAINAL ABIDINSYAH, NO.25,

KOMPLEX POHON PALA- ADMINISTRASI 0921-3126087| 0921-3126198 Y N Y ACTIVE ALL COVERAGE [email protected]

BANDA ACEH

1211 1789 KLINIK SPECIALIS CEMPAKA LIMAJL. TENGKU M. DAUD BEUREUEH NO

156PAK JEFRI Personalia

0651-33345 /

08126922264|- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1212 2187 APOTEK KIMIA FARMA LAMPRIETJL. TEUKU DAUD BEUREUEH NO. 167-

171

BPK. INDRA

PERMANAPIC 0651-637008| 0651-635 669 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1213 2186 APOTEK KIMIA FARMA 37 JL. DIPONOGORO NO 8BPK. INDRA

PERMANA- 0651-21559| 0651-635 669 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

[email protected]

1214 1790 RS. CEMPAKA AZ ZAHRAJL. POCUT BAREN NO 36-38-40 BANDA

ACEH

BPK KAMAL ZIZA/

IBU LIAMARETING 0651-31066| 0651-25281 Y Y Y ACTIVE ALL COVERAGE [email protected]

1215 3958APOTEK & KLINIK KIMIA FARMA 397

SIGLIJL. PERDAGANGAN NO.1 SIGLI - ACEH

M.BAGUS ANDREAS

TMARKETING 065321536| 65321536 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1216 1100 RS. TEUNGKU FAKINAH JL. JEND. SUDIRMAN NO.27-29BPK.TONI ZEIN /

IBU ASIHTATA USAHA

0651-41454 /

081377028888-|-0651-47646/49454 Y N Y ACTIVE ALL COVERAGE [email protected]

BIREUN

1217 1694 RS. TELAGA BUNDA BIERUN JL. PEUTUA BANTA NO 7, GP BIERUNBPK NURDIN / DR

NILA ETITA

MARKETING/

DIREKTUR0644-324433| 0644-324433 Y Y Y ACTIVE ALL COVERAGE [email protected]

LANGSA

1218 2667 KLINIK & APOTEK KF 81JL. TM.ZEIN NO.1E

,LANGSA,ACEHTIMUR

SRI RIZKI MAULIZA

S.SI. APT.farmacy 0641-21020| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1219 2711 RS. CUT MEUTIAJL. GARUDA NO. 1 KEL. KEBON BARU

LANGSA ACEHIBU SUSI - (0641) 426285| - Y Y Y ACTIVE ALL COVERAGE [email protected]

LHOKSEUMAWE

1220 1975 KLINIK VINCA ROSEAJL. DARUSSALAM NO. 36 -

LHOKSEUMAWEBAPAK AZHARI - 0645-7011117 / 46725| 0645-630218 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1221 1892 RS. SAKINAH LHOKSEUMAWE JL. ANTARA NO 30, LHOKSEUMAWEBPK PADLI/ IBU

IDA/ BPK HERIMARKETING 0645-45534/42158| - Y N Y ACTIVE ALL COVERAGE [email protected]

1222 2119 APOTEK KIMIA FARMA 60JL. MERDEKA NO. 47 B -C

LHOKSEUMAWE BANDA ACEH

IBU SINTA

(APOTEKER)- 0645-41152| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

MEULABOH

1223 3686 RS. SWASTA MONTELLAJL. BERINGIN JAYA SAMPING MESJID

AGUNG, MEULABOH, ACEH BARAT

ROSI NURUL

SAPUANMARKETING

(0655) 7551974;

085277358711|- Y Y Y ACTIVE ALL COVERAGE [email protected]

BIMA

1224 3506 KIMIA FARMA NO. 263 BIMA JL. SOEKARNO - HATTA NO. 3 BIMA BP TAUFIK - 0374-42910| N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

LOMBOK TIMUR

1225 1894 RS. ISLAM NAMIRA SELONGJL. KH AHMAD DAHLAN NO 7. KEC

SELONG KOTA SELONGBAPAK DODDY - 0376-22693/21004/| - Y Y Y ACTIVE ALL COVERAGE [email protected]

MALUKU

MALUKU UTARA

NAD

NTB

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 45 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1226 3503 KIMIA FARMA NO. 55 SELONG

JL. M. YAMIN NO. 77 SELONG -

LOMBOK TIMUR- - -| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

MATARAM

1227 1957 RSIA. PERMATA HATI MATARAM JL. MAJAPAHIT NO 8Ibu Aam Rizky

AmaliaMarketing 0370-631999| 0370-632999 Y Y Y ACTIVE ALL COVERAGE

permatahatimaternityclinic@yah

oo.co.id1228 1958 RB. TRESNA JL. BUNG KARNO NO.28 DEWANTORO MARKETING 0370-637965/630478| - N Y Y ACTIVE ALL COVERAGE [email protected]

1229 2257 KLINIK & APOTEK KF NO 134 JL. PEJANGGIK NO. 48 MATARAM - - 0370-638502| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1230 1956 RSI. SITI HAJAR MATARAM JL. CATUR WARGA NO. 6 MATARAMIBU HJ ERNI/ IBU

NINING- 0370-623498| - Y Y Y ACTIVE ALL COVERAGE

[email protected];rsi_sitihaj

[email protected]

1231 1645 RS. HARAPAN KELUARGA MATARAM

JL. AHMAD YANI NO. 9 SELAGALAS,

SANDUBAYA, MATARAM - LOMBOK

(NTB)

SULMAN HIDAYAT MARKETING0370-

670000,6177027,6177000|0370-673666 Y Y Y ACTIVE ALL COVERAGE

[email protected]

d

1232 1124 RSB. EXONERO JL. PEMUDA NO.16, DASAN AGUNG IBU LUSI MARKETING 0370-636454,644440|0370-

647023/636454Y N Y ACTIVE ALL COVERAGE [email protected]

1233 3507 KIMIA FARMA CATUR WARGA JL. CATUR WARGA NO. 17 MATARAM - - -| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1234 3505 KIMIA FARMA NO. 234 MATARAM JL. SELAPARANG NO. 53 MATARAM - - -| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1235 3504 KIMIA FARMA NO. 231 MATARAM JL. SALEH SUNGKAR NO. 33 AMPENAN - - -| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1236 1827 RS. BIOMEDIKA JL. BUNG KARNO NO 143 MATARAM IBU GITHA MARKETING 0370-645137| 0370-645138 Y Y Y ACTIVE ALL COVERAGE [email protected]

1237 1539 RS. RISA SENTRA MEDIKAJL. PEJANGGIK, NO.115,

CAKRANEGARAIBU IKA MARKETING 0370-632117/625560/| 0370-625559 Y Y Y ACTIVE ALL COVERAGE [email protected]

1238 2258 KLINIK & APOTEK KF NO. 189 JL. SRIWIJAYA NO. 295 MATARAM - - 0370-633211| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

SUMBAWA

1239 3482 KIMIA FARMA NO. 303 SUMBAWA JL. CENDRAWASIH SUMBAWA BESAR - - 0371 - 24029| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

ENDE

1240 3500 KIMIA FARMA KELIMUTU ENDE JALAN KELIMUTU ENDEGLOCESDO TOGAR

HASIHOLAN TAMBA- (0381)-2627456| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

KUPANG

1241 3464 RS. WIRASAKTI JL. MOH. HATTA KUPANGI NYOMAN DESEL

ARIANTA-

(0380)-821131 / 0380-

824735|- Y Y Y ACTIVE ALL COVERAGE [email protected]

1242 2972 RS. KARTINI KUPANGJL. FRANS SEDA NO.17,KELURAHAN

TUAK DAUN MERAH, KUPANG-85228IBU SEPVIAN MARKETING 0380-80265111| (0380) 831270 Y Y Y ACTIVE ALL COVERAGE [email protected]

1243 1380 KLINIK & APOTIK KARTINI JL. ELTARI I NO.2 DR.IKE PENGELOLA 0380-833010| 0380-820660 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1244 1647 RSIA. DEDARIJL. RANTAI DAMAI 69 D TDM OEBUFU

KUPANG-NTT

BPK DEVA KETUT

WIRYAMARKETING 0380-8553914/826774|

0380-

830041/8553914Y Y Y ACTIVE ALL COVERAGE [email protected]

1245 2242 KLINIK & APOTEK KF 135 KUPANG JL. M. HATTA 46 KUPANG BPK. ANTON Apoteker0380-

830944/820541/831296|- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]

om; [email protected]

1246 2245 KLINIK & APOTEK KF 101 KUPANG JL. HEREWILA NO. 38 KUPANG SULFIANTO - 0380- 827270| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1247 2666 KLINIK & APOTEK KF LALAMENTIK JL. WJ.LALAMENTIK,95 D-E, KUPANGMARYANTO YOSEPH.

S.FARM, APT- 0380-840362| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1248 3975 SILOAM HOSPITALS KUPANGJL. RW MONGINSIDI RT. 014 RW. 004

FATUTULI

DR. VERONIKA

HANNY, MARS.MARKETING 0380-8530900/8530911| 0380-8530933 Y Y Y ACTIVE ALL COVERAGE

veronica.hanny@siloamhospitals.

com

1249 2240 RS. ST CAROLUS BORROMEUS JL. HR. KOROH KM. 08 BELLO KUPANGDR. HERLY

SOEDARMADJI- 0380 - 8030530| - Y Y Y ACTIVE ALL COVERAGE [email protected]

SIKKA

JAYAPURA

1250 1384 RS. TK.II MARTHEN INDEY JL. DIPONEGORO, NO.57KAPTEN GEDE

SATRIA WLAB

0967-

537735/5763479/532491|0967-537735 Y Y Y ACTIVE ALL COVERAGE [email protected]

1251 4203 LAB. KLINIK CITO JL. ARGAPURA NO. 11 E, JAYAPURA BPK MUHADI KOORDINATOR0967-522080 /

085244202002|0967-522082 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

[email protected]

NTT

PAPUA

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 46 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1252 2189 APOTEK KIMIA FARMA 194 JAYAPURA JL. AHMAD YANI NO. 29 BP. PERDANA

PENANGGUNG

JAWAB0967-533 322| 0967-533 322 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1253 2188 KLINIK & APOTEK KF 172 JAYAPURA JL. AHMAD YANI NO. 67,JAYAPURA CHRISTINA BAY AST. APOTEKER 0967-534921/533 322| 0967-534921 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1254 1469 RS. DIAN HARAPANJL. TARUNA BHAKTI KEL YABANSAI

DISTRIK HERANG - JAYAPURA

IBU JASINTA

ANASTASIA, AMDKabag Sekretariat 0967-572325|

0967-

573362/573979Y Y Y ACTIVE ALL COVERAGE

rumahsakitdianharapan@yahoo.

com

MERAUKE

1255 0904 RSUD. MERAUKE JL. SUKARJO WIRYOPRANOTO IBU YERMINA KEPALA TU 0971-321125|-0971-

321124/325906Y Y Y ACTIVE ALL COVERAGE

[email protected]

m/[email protected]

1256 1045 RS. BUNDA PENGHARAPAN JL. KELAPA LIMA ANGKASA NO. 1 SR.CLARA MARKETING 0971-325906|- 0971-323596 Y Y Y ACTIVE ALL COVERAGE [email protected]

1257 4213 LAB. KLINIK CITO MERAUKEJL. RAYA MANDALA 293, MERAUKE

PAPUAYUSUF PAREBONG - 0971-325367| 0971-325368 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

[email protected]

TIMIKA

1258 2716 RS. KASIH HERLINAJL. A. YANI NO. 37 TIMIKA PAPUA

99910Ibu Herlina Direktur (0901) 321433/321443| (0901) 324310 Y Y Y ACTIVE ALL COVERAGE [email protected]

1259 2732 KLINIK PURI HUSADAJL. BUDI UTOMO UJUNG, TIMIKA

PAPUABAPAK PARDI Owner

(0901)

3126661/081240760444|- N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

[email protected];

SORONG

1260 1716 RS. TNI AL DR R. OETOJO SORONGJL. AHMAD YANI, KLADEMAK III C,

SORONGIBU NUR -

0951-321946 / 0951-

323823|0951-323823 Y Y Y ACTIVE ALL COVERAGE

[email protected] ;

[email protected]

1261 1475 RS. PERTAMINA SORONG JL. AHMAD YANI NO. 13 IBU FEBI MARKETING 0951-321362, 321581| 0951-326110 Y Y Y ACTIVE ALL [email protected];

[email protected]

1262 1468 RS. MUTIARA SORONG JL. MALEO, NO. 2-A, SORONG.BPK. M. FARID

SOAMANGON-

0951-

327433/324593/332061|0951-327433 Y Y Y ACTIVE ALL COVERAGE [email protected]

DUMAI

1263 1621KLINIK RAWAT INAP & BERSALIN

PADU SERASI

JL. JEND. SUDIRMAN NO. 188 DUMAI,

RIAUYULIANI - 0765-438189 / 438289| 0765-438008 N Y Y ACTIVE ALL COVERAGE [email protected]

1264 2766 KLINIK IGA DUMAIJL. SUTAN SYARIF KASIM NO.221,

DUMAI - RIAUDR. GABY -

0765-4397481/

085264881796|N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

[email protected]

DURI

1265 0624 RSIA. MUTIA SARIJL. BATHIN BETUAH, NO.1-A, SIMPANG

PADANGBPK YAHYA MARKETING 0765-93635/92080|

0765-

597972/55979Y Y Y ACTIVE ALL COVERAGE [email protected]

1266 0921 RS. PERMATA HATI DURIJL. JEND SUDIRMAN NO.37 SIMPANG

PADANG

IBU INEL/ ROSSA/

RINCEMARKETING

0765-94902/95799,

GIGI913670765-0765-

596899|0765-0765-596899

0765-595799 Y Y Y ACTIVE ALL COVERAGE [email protected]

1267 0922 KLINIK THURSINAJL. JEND SUDIRMAN NO.65 SIMPANG

PADANGIBU ELMA MARKETING

0765-5955730765-

595573|0765-5955730765-595573 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1268 0930 RSU. THURSINA JL. HANGTUAH NO.93 IBU ELMA MARKETING0765-5977820765-

595573|0765-5955730765-597773 Y Y Y ACTIVE ALL COVERAGE

[email protected];belmanj

[email protected]

INDRAGIRI HILIR

1269 2302 RS. INDRAGIRIJL. TRIMAS NO. 77 TEMBILAHAN

INDRAGIRI HILIR - RIAUBPK. ARS. YAD Marketing 0768-23555| 0768-21539 Y Y Y ACTIVE ALL COVERAGE [email protected]

PANGKALAN KERINCI

1270 1369 RS. EFARINA PANGKALAN KERINCIJL. LINTAS TIMUR NO 1, PANGKALAN

KERINCI, KAB PELALAWANIBU ERVINA - 0761-494500/493980| 0761- 493981 Y Y Y ACTIVE ALL COVERAGE [email protected]

PEKANBARU

1271 1535 EKA HOSPITAL PEKANBARU JL. SOEKARNO HATTA, KM.6,5BPK. AANNUR/IBU

ITAMARKETING 0761-6989999| 0761-6989944 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

1272 0920 RS. AWAL BROS PEKANBARU JL. JEND SUDIRMAN NO.117 BP RONI ISWANDI MARKETING 0761-47333-|- 0761-47222 Y Y Y ACTIVE ALL [email protected]/marketi

[email protected]

1273 2101 APOTEK KIMIA FARMA 229 JL. SUDIRMAN 724 PEKANBARU MACHALI APOTEKER 0761 29186| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1274 2102 KLINIK & APOTEK KF 93 PEKANBARUJL. JEND. SUDIRMAN NO 175

PEKANBARUAMINULHAM - 0761-32796| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1275 1596RS. KHUSUS BEDAH & KEBIDANAN

SYAFIRA

JL. JEND.SUDIRMAN NO.134

PEKANBARUIBU.TITIN MARKETING 0761-856517,35360| 0761-41887 Y Y Y ACTIVE ALL COVERAGE

info@rs-

syafira.com/babbynikicio@ymail.

com

1276 1444 RS. LANCANG KUNING JL. RONGGOWARSI. TO UJUNG, NO.5A IBU JUMI / IBU NIA MARKETING 0761-859273/859274| 0761-34672 Y Y Y ACTIVE ALL COVERAGE [email protected]

1277 0841 RSIA. ZAINAB JL. RONGGOWARSI. TO I NO.1 BPK. JANUAR MARKETING 0761-24000| 0761-859448 Y Y Y ACTIVE ALL COVERAGE [email protected]

RIAU

PAPUA BARAT

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 47 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1278 0664 RS. ISLAM IBNU SINA PEKANBARU JL. MELATI, NO.60ZACKY FAISAL/ IBU

FARAHHUMAS 0761-24242/26011| 0761-35698 Y Y Y ACTIVE ALL COVERAGE [email protected]

1279 0791 RS. PEKANBARU MEDICAL CENTERJL. LEMBAGA PEMASYARAKATAN

NO.25,GOBAH

DR. ZUL INDRA/IBU

FEBRI/BPK ADRIANMARKETING 0761-848100/859510| 0761-859510 Y Y Y ACTIVE ALL COVERAGE [email protected]

1280 0625 RS. SANTA MARIA PEKANBARU JL. A. YANI, NO.68IBU KANTI /

FRANSISKAHUMAS

0761-

28800,20235,20166,22213|0761-26071 Y Y Y ACTIVE ALL COVERAGE

[email protected]/fransisika@

yahoo.com

1281 2926 RSIA. ANDINIJL. TUANKU TAMBUSAI NO.55,

PEKANBARUDR WILMI / LINA - (0761) 33612| (0761) 33649 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected];

1282 4134 RS. PROF.DR.TABRANI JL.JEND. SUDIRMAN NO. 410 IBU AYU MARKETING 0761-35464| 0761-839114 Y Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1283 2837KLINIK MATA SUMATERA EYE

CENTER PEKANBARUJL. ARIFIN AHMAD NO. 58 PEKANBARU IBU ENI PIC 0761-565686| 0761-565786 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

smec_pekanbaru@smec-

group.com

1284 3003 PRAKTEK DRG. TENSY A. TJL. AHMAD YANI 111C ( APOTEK

PANGEAN ) PEKANBARUBAPAK BENNY -

081365910510 ;

081364223894|- N Y Y PARTIAL DENTAL

[email protected];

[email protected];

1285 0663 RSIA. ERIA BUNDA JL. KH. AHMAD DAHLAN, NO.163IBU TETTI

ROZA/EFAKEUANGAN 0761-23100/23600| 0761-47235 Y Y Y ACTIVE ALL COVERAGE [email protected]

1286 2409 RSIA. BUDHI MULIAJL.SOEKARNO HATTA NO.226-228

ARENGKA, PEKANBARUISMAIDA MARKETING 0761-3069900/8417200| 0761-8417255 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

1287 2590 RSB. ANNISA TANGKERANGJL. GARUDA NO. 66 TASKURUN UNJUNG

TANGKERANG TENGAH, PEKANBARURIO - (0761) 848 652| (0761) 848 652 Y Y Y ACTIVE ALL COVERAGE

marketingrsbersalinannisa@gmai

l.com

1288 2468 RS. AWAL BROS PANAM

JL. HR. SOEBRANTAS RT. 01/RW. 03

NO 88 KEL. TUAH KARYA KEC. TAMPAN

PANAM, PEKANBARU

DR CACA BUSSNISE DEV 0761-586 888| 0761 586111 Y Y Y ACTIVE ALL COVERAGE [email protected]

ROKAN HILIR

1289 2199 KLINIK AGUNGJALAN JEND. SUDIRMAN KM. 8, BAGAN

BATU - ROKAN HILIR - RIAU- - 0765-552459| 0765-552459 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

ROKAN HULU

1290 1878 RS. AWAL BROS UJUNG BATUJL. JEND. SUDIRMAN NO. 314 UJUNG

BATU ROKAN HULU RIAUELISA marketing 0762-7363329| 0762-7363334 Y Y Y ACTIVE ALL COVERAGE [email protected]

BATAM1291 0584 RS. AWAL BROS BATAM JL. GAJAH MADA KAV.1 BALOI IBU MARIA MARKETING 0778 - 431777| 0778-430777 Y Y Y ACTIVE ALL COVERAGE [email protected]

1292 0484 RB. BUDI ROSARIJL. MAHKOTA SIMPANG, NO.1,

BENGKONG MAHKOTA

BPK WIRA / IBU

NENENGKEUANGAN 0778-427854| 0778-432833 N Y Y ACTIVE ALL COVERAGE [email protected]

1293 1010 RS. ST. ELISABETH - BATAM JL. ANGGREK BLOK II, BALOIIBU PURNAMA/ IBU

MARIA

KEUANGAN/MARKE

TING0778 - 457357-|-

0778-

457710/422473Y Y Y ACTIVE ALL COVERAGE [email protected]

1294 0485 GENTA MEDICAL CENTER MUKA KUNING INDAH, BLOK F, NO.10 IBU LINDAPELAYANAN

PASIEN0778-361909| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

1295 0764 RS. HARAPAN BUNDA BATAM JL. SERAYA NO.1IBU NORA /

ARISTONMARKETING

0778-

457333/456444/458808077

8 - 458808|0778 - 458808

0778-456800 Y Y Y ACTIVE ALL [email protected]/n

[email protected]

1296 2448YAHYA MEDICAL CENTER & APOTIK

ZAHRUNI

KOMPLEK RUKO SAGULUNG PERMAI

BLOK B14-15, SAGULUNG KOTA,

BATAM

HAMDANI HRD (0778) 392748| (0778) 392749 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1297 2479 KLINIK & APOTEK KF 413KOMP. RUKO BOTANIA GARDEN BLOK A

1 NO. 1 C - BATAMDARMA, S.FARM Kepala Apotik 0778 7431199| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1298 2480 KLINIK & APOTEK KF 128KOMP. PERTOKOAN WIJAYA BLOK A NO.

4 SEI HARAPAN - BATAM

ROSMIDA KHOHAR,

S.SI- 0778 323697| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1299 2482 KLINIK & APOTEK KF 269JL. JEND SUDIRMAN, BATAM CENTRE,

BATAM

DRS. HERMANTA

TARIGAN- 0778 461482| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1300 2484 KLINIK & APOTEK KF 59JL. IMAM BONJOL, NO.1, NAGOYA,

BATAM

DRS. I KOMANG

KARTIKA YASA- 0778 458560| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1301 2486 KLINIK & APOTEK KF 137KOMP.SAGULUNG MAS INDAH B3,

BATAM

B. AGUNG WIDI N,

S.SI- 0778 392146| - N Y Y PARTIAL H&S,MAT -

1302 2503 RS. GRAHA HERMINEKOMP. RUKO ASIH RAYA NO.9-15,

BATU AJIFITRI - (0778) 363318, 363127| (0778) 363164 Y Y Y ACTIVE ALL COVERAGE [email protected]

1303 2487 KLINIK & APOTEK KF 224KOMP MUKA KUNING INDAH II B2.3,

BATAM

ADHLIN YULSYAR,

S.FARM- 0778 363375| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1304 4150 KLINIK & APOTEK KF NO. 230 PANBIL MALL BLOK A NO. 5

DRA. ITA

TAURIESTANINGTYA

S, Apt

- 0778-371149| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

BINTAN

RIAU KEPULAUAN

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 48 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1305 1240 RB. & BP TIARA MEDIKA

JL. KAMPUNG HARAPAN RT 01/01

TELUK SASAH, TANJUNG UBAN

DR.ERIKA KAMIL/

IBU OJIPEMILIK/ ADM 0771-484427| 0771-484427 Y Y Y PARTIAL

GP,SP,OP,DENTAL,MAT,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

[email protected]

1306 1241 KLINIK BERSALIN ERNES JL. PERMAISURI NO.8 TANJUNG UBANDR.ODRI AGNES/

IBU INDRAACOUNTING 0771-483212| 0771-482738 Y Y Y ACTIVE ALL COVERAGE [email protected]

BINTAN UTARA

1307 2457 RSUD. TANJUNG UBANJL. INDUN SURI SIMPANG BUSUNG

NO.1 TANJUNG UBAN 29152

RANTI/ BPK IYAN

GUMILANGHUMAS

(0771) 482655/

082324421982|- Y Y Y ACTIVE ALL COVERAGE [email protected]

KARIMUN

1308 1271 RS. BAKTI TIMAH KARIMUN

JL. CANGGAI PUTRI TELUK UMA

KABUPATEN KARIMUN PROVINSI

KEPULAUAN RIAU 29661

IBU SERLY MARKETING 0777-7367085| 0777-7333251 Y Y Y ACTIVE ALL COVERAGE [email protected]

1309 1291 APOTIK DEVI FARMAJL. AHMAD YANI, SEI PASIR, MERAL,

TANJUNG BALAIBPK.RACHMADI PEMILIK 0777-21388|

0777-

368974/21388N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1310 0874 RSB. GRAHA RAPJL. R.USMAN, BATU LIPAI, TANJUNG

BALAIDR.RIDWAN A. PEMILIK 0777-325600,326097| 0777-323857 Y Y Y ACTIVE ALL COVERAGE [email protected]

1311 1237 KLINIK SAYANG IBUJL. AHMAD YANI, NO.20, BARAN SATU,

MERAL, TANJUNG BALAI

DR.AWANG LIM /

IBU ELIPEMILIK 0777- 216 76| 0777- 222 52 N Y Y ACTIVE ALL COVERAGE [email protected]

TANJUNG PINANG

1312 2483 KLINIK & APOTEK KF 31 JL. BINTAN 656-658,TG.PINANGM. TRI KURNIAWAN,

S.SI- 0771 22879, 21091| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

-

[email protected]

m

MAMUJU

1313 4087 RSUD. MAMUJUJL. RE. MARTADINATA MAMUJU -

SULBAR

DR. H. HARMAN

HABADirektur 0426-21107| - Y Y Y ACTIVE ALL COVERAGE [email protected]

MAKASSAR

1314 2657 KLINIK & APOTEK KF HERTASNING JL. HERTASNING NO 11 - MAKASSARDRS. ROY

MUSTAKIM, APT.- 0411- 442945| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1315 1630 RS. AWAL BROS MAKASSARJL. JEND. URIP SUMOHARJO NO.43

MAKASSAR

IBU. INDAH SARI

MAHMUDMARKETING 0411-454567/452725|

0411-

459288/455123Y Y Y ACTIVE ALL COVERAGE [email protected]

1316 0644 RS. HIKMAH JL. YOSEF LATUMAHINA NO.1 IBU HERLINA MARKETING0411 - 872284,8714030411-

871403|0411-871403

0411 -

870964,871403Y Y Y ACTIVE ALL COVERAGE [email protected]

1317 1393 RSIA. SITI KHADIJAH 1 MAKASSAR JL. KARTINI NO.15-17 MAKASSARIBU FITRI/

MUBARAQMarketing 0411-3624554/8614661| 0411-3627119 Y Y Y ACTIVE ALL COVERAGE [email protected]

1318 1390 RS. IBNU SINA YBW-UMI JL. URIP SUMOHARJO, KM.5, NO.264 DR.DAHLIAH PELAYANA MEDIS0411-

452958/5781595/452917|0411-425397 Y Y Y ACTIVE ALL COVERAGE [email protected]

1319 1389 RS. GRESTELINA JL. LETJEN HERTASNING RAYA NO.51DR. BENHARD

KATUUK, IBU LILIKMARKETING 0411-448855/448852| 0411-448854 Y Y Y ACTIVE ALL COVERAGE [email protected]

1320 1388 RATULANGI MEDICAL CENTRE JL. SAM RATULANGI NO.28 IBU YURIKE MARKETING 0411-878605/06/88| 0411-878587 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected];

[email protected]

1321 2717 KLINIK & APOTEK KF 38 JL. HASANUDDIN, NO.46, MAKASSARDRS. YUNI ASMAN,

APT.- 0411- 3617110| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1322 2661 KLINIK & APOTEK KF 250 JL. DR.RATULANGI 59, MAKASSARDRS. FAEDAL B.,

APT.- 0411- 582895| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1323 2660 KLINIK & APOTEK KF DAENG TATA JL. DAENG TATA 69, MAKASSARDRS. ROY

MUSTAKIM, APT.- 0811403255| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1324 2659 KLINIK & APOTEK KF PETTARANI JL. PETTARANI 18, MAKASSARDRS. ROY

MUSTAKIM, APT.- 0411-857210 / 857215| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1325 2658 KLINIK & APOTEK KF 33JL. AHMAD YANI, NO.17 - 19,

MAKASSAR

DRS. ROY

MUSTAKIM, APT.- 0411-3616722| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1326 0641 RS. STELLA MARIS MAKASSAR JL. SOMBA OPU NO.273, PO.BOX 122IBU CHRISTINA/IBU

DEVIKERJASAMA 0411-871391/873346| 0411 - 859545 Y Y Y ACTIVE ALL COVERAGE

[email protected];

marketing@rsstellamari

1327 2178 APOTEK FARMARIN MAKASSARJL. SAMRATULANGI NO. 51 D

MAKASSAR

DRS. DAUD MANDI,

APT- 0411-877551/ 0811414971| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1328 1847 SILOAM HOSPITALS MAKASSAR

JL. METRO TANJUNG BUNGA KAV. 9

PANAMBUNGAN KEC. MARISSO -

MAKASAR

PUTRI AMELIA BUSDEV MANAGER

0411-

8117555/8117430/5290000

/3662900|

0411-8117911 Y Y Y ACTIVE ALL [email protected]

m

1329 3085 RS. UNIVERSITAS HASANUDDINJL. PERINTIS KEMERDEKAAN KM.11

MAKASSAR 90245IBU MIRNA - 0411 - 591331| - Y Y Y ACTIVE ALL COVERAGE [email protected]

1330 3065 RSB. SENTOSA MAKASSAR JL. JEND. SUDIRMAN 52,IBU FRIESYE

(081342580333)marketing 0411-3612720| (0411) 3619711 Y Y Y ACTIVE ALL COVERAGE [email protected]

SULAWESI BARAT

SULAWESI SELATAN

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 49 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1331 2291 KLINIK & APOTEK KF 199 ERLINA

JL. URIP SUMOHARJO NO. 32

MAKASSAR- - 0411 449 936| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

PALOPO1332 0914 RS. AT MEDIKA JL. ANDI JEMMA, NO.09 AMRULLAH - 0471-21596-|- 0471-23008 Y Y Y ACTIVE ALL COVERAGE [email protected]

1333 2107 RS. BINTANG LAUT JL. K HM KASYIM NO. 5 PALOPO IBU TANTI MARKETING 0471-21302/21059| - Y Y Y ACTIVE ALL [email protected]

d

PARE PARE

1334 1394 RS. FATIMA PARE-PARE JL. ILHAMV KOTAK POS 12IBU IDA / IBU

MERRYMARKETING 0421-21847| 0421-21328 Y Y Y ACTIVE ALL COVERAGE [email protected]

SENGKANG

PALU

1335 0639RSU. WOODWARD (BALA

KESELAMATAN)JL. LH. WOODWARD NO.1 BPK.FREDIK MARKETING 0451 - 421769, 423744| 0451 - 423744 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

1336 2288 KLINIK & APOTEK KF 390 PALUJL. SETIABUDI NO. 65 D PALU

SULTENG- - -| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1337 2287 APOTEK KIMIA FARMA 449 TATURAJL. WOLTER MONGINSIDI NO. 145

PALU, SULTENGBP MUSLIM - 0451-429832| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

BAU BAU

1338 2300 RS. MURHUM

JL. SULTAN MURHUM NO. 69 KEL.

WAJO KEC. MURHUM SULTENG, BAU

BAU

BP H FUAZI - 0402-2822650| 0402-2823919 Y Y Y ACTIVE ALL COVERAGE -

KENDARI

1339 1537 RS. ST. ANNA JL. DR. MOH.HATTA, NO.65A BPK.MATIUS MARDI KEUANGAN 0401-3123092| 0401-3124872 Y Y Y ACTIVE ALL COVERAGE [email protected]

1340 2286 KLINIK & APOTEK KF 288 JL. A. YANI NO. 84 KENDARI Firdaus - 0401 319 6186| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1341 2285 APOTEK KIMIA FARMA 104JL. MOH. HATTA NO. 77 KENDARI

93124Darlin - 0401 3127182| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

KOTAMOBAGUMANADO

1342 1798 SILOAM HOSPITALS MANADO JL. SAM RATULANGI NO 22 MANADOBP. SELFIANUS /

IBU FRANSIENMARKETING

0431-

8883180/8883131/8883911

|

0431-8883133 Y Y Y ACTIVE ALL COVERAGEselfianus.runtu@siloamhospitals.

com

1343 2805 RSIA. KASIH IBU MANADOKOMPLEKS BAHU MALL BLOCK. C NO.

23) JL. N. WOLTER MONGINSIDI NO. 1ibu Jane marketing 0431 834780/834667| 0431 834721 Y Y Y ACTIVE ALL COVERAGE [email protected]

1344 2230 KLINIK & APOTEK KF NO. 74JL. SAM RATULANGI NO.31 MANADO

93117BPK RIDWAN - 0431-864012| 0431-850838 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1345 2232 KLINIK & APOTEK KF WENANG 309JL. LIMIMUNT NO. 12 A KEL. TIKALA

KUMARAKA, KEC. WENANG, MANADO

BPK RUDI

AVIANSYAH- 0431-867163/840087| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1346 2231 APOTEK KIMIA FARMA MALALAYANG KP. REL NO. 5 RS. VP MALALAYANGBPK DUDI

ABDULRAHMAN- 0431-838278| 0431-838277 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1347 1502 RS. ADVENT MANADO JL. 14 FEBRUARI, NO.1, TELING ATAS BP MODI MAMAHID MARKETING 0431-847950/858429| 0431-850012 Y Y Y ACTIVE ALL COVERAGE [email protected]

BUKIT TINGGI

1348 2114KLINIK & APOTEK KF 146 BUKIT

TINGGI

JL. JEND. SUDIRMAN NO 14 BUKIT

TINGGI- - -| - N Y Y PARTIAL

H&S,GP,SP,OP,DENTAL,LAB,RM-

RI,RM-RJ,RM-RG,RM-KM,RM-

RB,PHAR

-

1349 1398 RSU. MADINA JL. GURU HAMZAH NO.17 BPK.JOHN HENDRI Medical Record 0752-21388 EXT 228| 0752-626677 Y Y Y ACTIVE ALL COVERAGE [email protected]

1350 0687 RS. ISLAM IBNU SINA BUKIT TINGGI JL. BATANG AGAM, BELAKANG BALOK IBU DEWI MARKETING 0752 - 21185| 0752-34009 Y Y Y ACTIVE ALL COVERAGE [email protected]

PADANG

1351 1569 RSIA. CICIKJL. DR. SUTOMO NO.94 MARAPALAM

PADANG 25125BPK. FARDINA MARKETING (0751) 38846; 38866| (0751) 841286 Y Y Y ACTIVE ALL COVERAGE [email protected]

1352 0616 RS. YOS SUDARSO JL. SITUJUH, NO.1 IBU HELEN MARKETING 0751-33230/33231| 0751-31811 Y Y Y ACTIVE ALL COVERAGE [email protected]

1353 0423RSU. BUNDA MEDICAL CENTER (RSU.

C-BMC)JL. PROKLAMASI NO.31-33-37 PADANG BPK ADRIAN MARKETING

0751-

23164/29536/21151/24750|0751-23200 Y Y Y ACTIVE ALL COVERAGE [email protected]

1354 2714 SEMEN PADANG HOSPITALJL. BY PASS KM 7 KEL. PISANG, KEC.

PAUH PADANG - SUMBAR

DR. MISS

BERLYANTI-

(0751) 777888, 4782999.,

4782997|(0751) 4782990 Y Y Y ACTIVE ALL COVERAGE

1355 0304 RS. SELAGURI JL. A.YANI, NO.26 IBU FAYNEM MARKETING 0751 -33010/21953| 0751-840051 Y Y Y ACTIVE ALL COVERAGE [email protected]

1356 1320 RSI. SITI RAHMAH PADANGJL. RAYA BY PASS KM 15 AIE PACAH,

PADANGIBU YORI -Marketing 0751-463059| 0751-463531 Y Y Y ACTIVE ALL COVERAGE [email protected]

SULAWESI TENGAH

SULAWESI TENGGARA

SULAWESI UTARA

SUMATERA BARAT

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 50 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1357 2369RS. MATA PADANG EYE CENTER

(PEC)JL. PEMUDA NO. 53 PADANG - SUMBAR SDR. SILVIA - 0751-30094| - Y Y Y ACTIVE ALL COVERAGE [email protected]

1358 4070 RSIA. ANNISA PADANG JL. PEMUDA NO. 18, PADANG IBU MAI ZURYATI MARKETING (0751) 31906| (0751) 31905 Y Y Y ACTIVE ALL COVERAGE [email protected]

1359 4051 RSIA. SITI HAWA JL. PARAK GADANG RAYA NO.35 IBU ENDANG Marketing 0751-841251| - Y Y Y ACTIVE ALL COVERAGE [email protected]

1360 2060 KLINIK & APOTEK KF 94 PADANG JL. PROKLAMASI N. 24 PADANG RONI KA-HUMAS 0751-891195| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1361 2113 KLINIK & APOTEK KF 238 PADANG JL. PATIMURA NO 18 PADANG AHMAD SYAHRONI - 0751-23620| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

PAYAKUMBUH

1362 2115KLINIK & APOTEK KF 372

PAYAKUMBUHJL. JEND. SUDIRMAN PAYAKUMBUH JUNIARTI apoteker -| KF_ N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR

[email protected]:

[email protected]

TEBING TINGGI

BATU RAJA

1363 1284 RS. SANTO ANTONIOJL. KOMISARIS UMAR NO. 33,

BATURAJASR. M. SKOLASTIKA HUMAS

0735-

320395/322418/324700|0735-320201 Y Y Y ACTIVE ALL COVERAGE [email protected]

DELI SERDANG

1364 3994 RS. SARI MUTIARA LUBUK PAKAMJL. MEDAN NO.17 LUBUK PAKAM

SUMUT

MELKY

TAMPUBOLONMARKETING (061) 7951339| (061) 7951344 Y Y Y ACTIVE ALL COVERAGE [email protected]

LUBUK LINGGAU

1365 2715 RS. AR BUNDA LUBUK LINGGAU

JL. GARUDA NO 245 RT 03 KEL.

BANDUNG KIRI, KEC. LINGGAU BARAT

1

- - (0733) 324955/324963| (0733) 321892 Y Y Y ACTIVE ALL COVERAGE [email protected]

1366 1869 KLINIK SEKATAJL. YOS SUDARS. O NO. 230 TABAH

JEMEKEH, LUBUK LINGGAU

DR CHRISTANTO

BEKTI PRASETYOKoordinator dokter 0733-321357| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

PALEMBANG

1367 2839 POLIKLINIK PERTAMINA PALEMBANGJL. JEND. AHMAD YANI NO. 1247. 1

PALEMBANGDR. MAHARANI penanggung jawab -| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,PHAR-

1368 0817 RS. RK. CHARITAS JL. JEND. SUDIRMAN NO.1054

BPK.AGUSMAN/ZR.E

MI/JUANDI JAYA

KOSIM

MARKETING0711-350426/3533750711-

353374/5|0711-353374/5

0711-

362205/377088Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

1369 0803 RS. MYRIAJL. KOL. H. BURLIAN KM. 7 NO 228

PALEMBANGCHRISTIN MARKETING

0711-

411610/412433/421914|0711-414052 Y Y Y ACTIVE ALL COVERAGE

[email protected];

[email protected]

1370 0885 RSIA. YK. MADIRAJL. JEND SUDIRMAN NO.1051 C-D

PALEMBANGIBU SUKMA MARKETING

0711-364954,362766,

374802, 3747850711-

356173|0711-356173

(0711) 356173 Y Y Y ACTIVE ALL COVERAGE [email protected]

1371 0627 RS. PUSRI JL. MAYOR ZEN, KOMPLEK PUSRI NO. 1 BPK ROSMAN MARKETING 0711 -712222-712111| 0711-712071 Y Y Y ACTIVE ALL [email protected]/rumkit@

pusri.co.id

1372 0688RS. ISLAM SITI KHADIJAH

PALEMBANG

JL. DEMANG LEBAR DAUN, LORONG

PAKJO

IBU NALA RESMINI /

BPK ARISHUMAS 0711-356008| 0711-311884 Y Y Y ACTIVE ALL COVERAGE

rsisitikhadijahpalembang@yahoo

.co.id

1373 0883 RS. BUNDA PALEMBANG JL. DEMANG LEBAR DAUN, PALEMBANG TEGUH / ERNITAWADIR /

MARKETING

0711-312866,3118660711-

311866|0711-3118660711-355553 Y Y Y ACTIVE ALL COVERAGE [email protected]

1374 1622 RS. HERMINA PALEMBANG

JL. BASUKI RAHMAT NO.897

RT.011/003 KEL.20 ILIR II

KEC.KEMUNING

DR. EVA MARKETING 0711-352525| 0711-366945 Y Y Y ACTIVE ALL COVERAGEpalembang@herminahospitalgru

op.com

1375 1642 RS. PELABUHAN PALEMBANGJL. MAYOR MEMET SASTRAWIRYA NO 1

BOOM BARU PALEMBANG

IBU SELVY/ BP

HAMIDMARKETING

0711-

711843,712840,712916,719

741|

0711-717100 Y N Y ACTIVE ALL [email protected];rsp

[email protected]

1376 1884 SILOAM SRIWIJAYA PALEMBANGJL. POM IX KEL. LOROK PAKJO KEC.

ILIR BARAT 1 PALEMBANGIBU DEBBY / HANNY MARKETING 0711-5229100| 0711-5649100 Y Y Y ACTIVE ALL COVERAGE

[email protected]

om

1377 2787 RS. PERTAMINA PLAJU PERTAMEDIKA

JL. BERINGIN NO.1 KOMPLEK

PERTAMINA PLAJU SUMATERA SELATAN

30268

BPK AMAL - (0711) 597401| (0711) 542388 Y Y Y ACTIVE ALL COVERAGE [email protected]

1378 3965 RS. SRIWIJAYA EYE CENTERJL. JEND.SUDIRMAN KM. 4,5 NO.502

KEL. 20 ILIR, KEC. IT IIBU NITA MARKETING (0711) 5611976/419680| Y Y Y ACTIVE ALL COVERAGE

sriwijayaeyecentre.hospital@yah

oo.com

1379 2185 KLINIK & APOTEK KF 209 JL. ISKANDAR MUDA NO. 222BPK. UNDIANTO (BM

PALEMBANG)- 0711354717/0711362245| - N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1380 2423 RSIA. AZZAHRAJL. BRIGJEN HASAN KASIM NO.1-2

BUKIT SANGKAL PALEMBANGIBU.KIKI MARKETING 0711-822723| 0711-826044 Y Y Y ACTIVE ALL COVERAGE -

1381 2394 KIMIA FARMA 239 PALEMBANG JL. MP. MANGKUNEGARA, PALEMBANG BPK. AMIR - 0711 - 823503| - N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

PRABUMULIH

1382 1449 RS. AR BUNDA PRABUMULIHJL. ANGKATAN 45, KEL GUNUNG IBUL

PRABUMULIH TIMURIBU MARTINI MARKETING 0713-322954, 7003330|

0713-

325980/322954Y Y Y ACTIVE ALL COVERAGE

[email protected]/h

[email protected]

SUMATERA SELATAN

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 51 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1383 3953 RS. FADHILAHJL. JENDRAL SUDIRMAN NO. 01 PATIH

GALUNG PRABUMULIHIBU PUJI RAMADIN - (0713) 3300032| (0713) 3300032 Y Y Y ACTIVE ALL COVERAGE [email protected]

1384 0824 RS. PERTAMINA PRABUMULIHJL. KESEHATAN, NO.100, KOMPLEK

PERTAMINA PRABUMULIHIBU SULASMI/ AYU MARKETING

0713-

383333/382749/322069/38

2742/382731(0713)

382731|(0713) 382731

0713-

321903/325181Y Y Y ACTIVE ALL COVERAGE [email protected]

ASAHAN

1385 2351 RS. SETIO HUSODOJL. S. M. RAJA N0 67 KISARAN,

ASAHAN SUMATERA UTARABPK. AMIN - 0623-44999| 0623-43394 Y Y Y ACTIVE ALL COVERAGE [email protected]

BINJAI

1386 1811 RS. BIDADARI BINJAIPERINTIS KEMERDEKAAN NO 174 A

KEBUN LADA KOTA BIJAIIBU RINI - 061- 8830003| 061 - 8826004 Y Y Y ACTIVE ALL COVERAGE [email protected]

1387 1652 RS. LATERSIAJL. SOEKARNO HATTA, KM.18 NO.451,

BINJAIIBU ENDANG MARKETING 061-8829588/8829788| 061-8822565 Y Y Y ACTIVE ALL COVERAGE [email protected]

1388 1624 RSU. ARTHA MEDICA JL. SAMANHUDI NO. 22 BINJAI SRI HARNI MUKTI - 061-8827277| 061-8830757 Y Y Y ACTIVE ALL [email protected] ;

[email protected].

BRASTAGI

1389 1542 RS. EFARINA ETAHAM BRASTAGI JL. JAMIN GINTING, NO.1, DESA RAYA,

BPK.YAHYA

SEMBIRING/IBU

ELFINA

MARKETING 0628-323716/17| 0628-213718 Y Y Y ACTIVE ALL COVERAGE [email protected]

DELI SERDANG

1390 4088 RS. HIDAYAH DELI TUA JL. MEDAN DELI TUA KM 8,5 NO.55 DEVI MARKETING 061 - 7032835| - Y Y Y ACTIVE ALL COVERAGE [email protected]

KISARANLANGKAT

1391 1653RS. PERTAMINA PANGKALAN

BRANDAN

JL. WAHIDIN NO.01 PANGKALAN

BRANDAN LANGKAT-SUMUTIBU TETI PEMASARAN 0620-322612,322455| 0620-323392 Y Y Y ACTIVE ALL COVERAGE [email protected];

LUBUK PAKAM

1392 2023 RS. GRAND MEDISTRA LUBUK PAKAMJL. RAYA MEDAN-LUBUK PAKAM KM 25

NO. 66BPK LUKMAN

HUMAS

MARKETING061-7955114| 061-7950114 Y Y Y ACTIVE ALL COVERAGE [email protected]

MEDAN

1393 2754 RS. DELI JL. MERBABU NO.18-20, MEDANIBU TINA / DR. EKA

PUTRA- (061) 4565229| (061) 4552361 Y Y Y ACTIVE ALL COVERAGE [email protected]

1394 3957 RS. ROYAL PRIMA MEDANJL. AYAHANDA NO. 68 A, MEDAN -

SUMATERA UTARAIBU NOVI/ROMA MARKETING

(061) 8881 3182; 8881

3183|(061) 8001 3181 Y Y Y ACTIVE ALL COVERAGE [email protected]

1395 0416 RS. MATERNA JL. TEUKU UMAR NO.11 IBU BUNI / IBU UUT MARKETING 061 -4514222| 061-4155392 Y Y Y ACTIVE ALL COVERAGE [email protected]

1396 0773 RSU. PROF.DR.BOLONI JL. W. MONGINSIDI NO. 11 MEDAN JUWITA/ROULINA MARKETING/KEU(061) 4512687; 4556879;

4154637|(061) 4154621 Y Y Y ACTIVE ALL COVERAGE [email protected]

1397 0590RS. COLUMBIA ASIA MEDAN (D/H

GLENI MEDAN)JL. LISTRIK 2A MEDAN 20112 IBU IDHA HIDAYATI MARKETING 061-4566368|

061-

4566585/4515453Y Y Y ACTIVE ALL COVERAGE

marketing.medan@columbiaasia

.com

1398 0523 RS. ADVENT MEDAN JL. GATOT SUBROTO, KM. 4 BP ANDRI TOMPUL MARKETING 061 - 4524875/4574025| 061-4154839 Y Y Y ACTIVE ALL COVERAGE [email protected]

1399 0418 KLINIK SPESIALIS BUNDA JL. SISINGAMANGARAJA NO.17IBU DELI NAFRI/IBU

LISMAINIMARKETING 061 -7321666| 061-7344786 N Y Y ACTIVE ALL COVERAGE

[email protected]/apriyenn

[email protected]

1400 0925 RS. ST ELISABETH - MEDAN JL. H. MISBAH NO.7, MEDAN JUNIAR SINAGA SEKERTARIS

061-

4144737/4522010/4144240

|

061 - 4143168 Y Y Y ACTIVE ALL COVERAGE [email protected]

1401 0742 RSU. MARTHA FRISKAJL. KOL. YOS SUDARS. O KM.6, NO.91,

PULO BRAYAN

IBU VERONIKA/

MAYA/ ERLIANA

CUSTOMER

SERVICE061-6610910| 061-6612005 Y Y Y ACTIVE ALL COVERAGE [email protected]

1402 1193 RSU. SARAH JL. BAJA RAYA NO. 10 PETISAH IBU YANTI MARKETING 061-4528044| 061-4529454 Y Y Y ACTIVE ALL [email protected];

[email protected]

1403 1061 RS. ESTOMIHIJL. SISINGAMANGARAJA NO.235

MEDANIBU ELIS MARKETING

061-7861771,7864656061-

7864656|061-7864656061-7866660 Y Y Y ACTIVE ALL COVERAGE [email protected]

1404 0741 RS. ISLAM MALAHAYATI JL. DIPENOGORO NO.2-4, MEDAN IBU ADE Marketing 061 - 4518766| 061-4519474 Y Y Y ACTIVE ALL COVERAGE [email protected]

1405 0740 RS. HERNA JL. MAJAPAHIT NO.118A, MEDAN IBU HERLINA MARKETING061 -451 0766|IBU HENI/DR

LIMENTA061-415 3955 Y Y Y ACTIVE ALL COVERAGE [email protected]

1406 1592 RSIA. STELLA MARIS MEDAN JL. SAMANHUDI NO.20 MEDAN IBU HALINA Bag. Finance 061-4158383| 061-4157088 Y Y Y ACTIVE ALL COVERAGE [email protected]

1407 0322 RSU. PERMATA BUNDA MEDAN JL. SISINGAMANGARAJA, NO.7IBU FAUZIAH /

ADIST / RANIMARKETING

061-7362777 / 7360120 /

7367980 EXT. 141|061-7320222 Y N Y ACTIVE ALL COVERAGE [email protected]

1408 0626 RS. SARI MUTIARA JL. KAPTEN MUSLIM, NO.79 IBU KIKI MARKETING 061-8451812| 061-8452134 Y Y Y ACTIVE ALL COVERAGE [email protected]

1409 1649 RS. IMELDA PEKERJA INDONESIAJL. BILAL NO 24 PULO BRAYAN DARAT

I MEDAN TIMURIBU MARIA MARKETING 061-6610072-6631380| 061-6618457 Y Y Y ACTIVE ALL COVERAGE [email protected]

1410 1651 RS. BUNDA THAMRIN MEDANJL. SEI BATANG HARI NO. 28/30

MEDAN SUNGGAL

Bpk HERLINSON /

IBU KIKIMARKETING

061-

4553928,88813615,455731

8,4557218,4553918|

061-4558218 Y Y Y ACTIVE ALL COVERAGE [email protected]

1411 3779 RS. SILOAM DHIRGA SURYAJL. IMAM BONJOL NO. 6, KEL. PETISAH

- MEDAN 20112

EFFENDY/CHARLES

AMIN-

(061) 8888 1900 EXT.

22601|(061) 8888 1933 Y Y Y ACTIVE ALL COVERAGE

effendy.pangestu@siloamhospita

ls.com

1412 4091 RSU. SUNDARI JL. TB SIMATUPANG NO 31 MEDANIBU RINI

KURNIAWATIMARKETING 061-8452536-|- 061-8452536 Y Y Y ACTIVE ALL COVERAGE [email protected]

SUMATERA UTARA

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 52 14/08/2015

No Code Hospital Name Address Contact Person Division Tel Number Fax Number RI RJ FLAG Status Allowed Emails

LIST PROVIDER INDEMNITY UPDATE PER 31 JULI 2015

KHUSUS PT. BANK MANDIRI (PERSERO) Tbk, PT MAYORA Tbk, dan TELADAN PRIMA GROUP

BALI1413 1650 RS. MARTHA FRISKA MULTATULIJL. MULTATULI KOMP. MULTATULI

INDAH NO 1 MEDANIBU DAI MARKETING

061-4149666 /

08286103148|061-4154761 Y Y Y ACTIVE ALL COVERAGE [email protected]

1414 4092 RSIA. SRI RATU JL. NIBUNG RAYA NO 204-212 MEDANIBU EKA

BERNADETAHRD 061-4521074| 061-4539236 Y Y Y ACTIVE ALL COVERAGE [email protected]

1415 4001 RS. MADANI MEDAN

JL. A.R. HAKIM NO. 168, KEL. SUKA

RAMAI I, KEC. MEDAN AREA, KOTA

MEDAN

IRNA PRATIWI MARKETING061-7345911, 061 -

7361357|Y Y Y ACTIVE ALL COVERAGE [email protected]

1416 2028 RS. MITRA SEJATI MEDANJL. AH. NASUTION PANGKALAN

MAHSYUR NO.7, MEDAN

IBU SUSAN

NOVRINI/BAPAK

SUEP

- 061-7875967/ 7881682| 061-7850261 Y Y Y ACTIVE ALL [email protected];

susan.novrini@gmail.

1417 2053 MURNI TEGUH MEMORIAL HOSPITALJL. JAWA NO. 2 SIMPANG JL.

VETERANOMPON marketing 061-80501888/777| 061 - 80501800 Y Y Y ACTIVE ALL COVERAGE

[email protected]

m

1418 2182 KLINIK & APOTEK KF 27 JL. PALANG MERAH NO. 32DRSB. ISMA

PANDIA,APTAPOTEKER 061-4576023| 061-451551 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1419 2297 KLINIK GRAND MADANIJL. SETIA BUDI KOMP. SETIABUDI

POINT BLOK E 12-13, MEDANIBU DEWI APOTEKER 061-8222345| 061-8222929 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1420 2179 APOTEK FARMARIN MEDANJL. GATOT SUBROTO NO. 14 KM 4,2

MEDAN PETISANIBU. RATIH/SRI - 061- 4528454| 061- 4528464 N Y Y ACTIVE ALL COVERAGE [email protected]

1421 2183 KLINIK & APOTEK KF 39 JL. GATOT SOEBROTO NO 37 A/C

RICKY U

MARPAUNG,S.FARM,

APT

APOTEKER 061-4529909| 061-4532717 N Y Y PARTIALGP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1422 2395 SUMATERA EYE CENTER JL. ISKANDAR NO. 278 - 280, MEDANBPK. FAJARUDDIN

NASUTION- 061-4525058 ; 4518222| 061-4510978 Y Y Y ACTIVE ALL COVERAGE

[email protected]

d

PEMATANG SIANTAR

1423 0719 RS. VITA INSANI JL. MERDEKA, NO.329 IBU SUSAN MARKETING 0622-22520| 0622-24521/29133 Y Y Y ACTIVE ALL [email protected];rsvi

@vita-insani.co.id

1424 2208 KIMIA FARMA SOETOMOJL. SUTOMO NO.63 PEMATANG

SIANTARBPK IDRIS - 0622-22447| 0622-25527 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

1425 2984 RS. HARAPAN PEMATANG SIANTAR

JL. FAREL PASARIBU NO : 21

PEMATANG SIANTAR, SUMATERA

UTARA

NESLI M PURB. A Marketing 0622-21162, 21612| 0622-435301 Y Y Y ACTIVE ALL COVERAGE [email protected]

1426 0924 RS. HORAS INSANI JL. MEDAN KM.2,5 PEMATANG SIANTARIBU.CHRISTINA/JUL

TRI/SUZANNAMARKETING

0622-

433444,433877,433666,433

7770622-433777|0622-

433777

0622-21384 Y Y Y ACTIVE ALL [email protected]/rshi

@indo.net.id

1427 2209 KIMIA FARMA KARTINIJL. KARTINI NO. 19 PEMATANG

SIANTARIBU SABRINA APOTEKER 0622-22448| 0622-25527 N Y Y PARTIAL

GP,SP,OP,DENTAL,LAB,RM-RI,RM-

RJ,RM-RG,RM-KM,RM-RB,[email protected]

SIBOLGA

1428 2249 RS. METTA MEDIKAJL. SUTOYO SISWOHARJO NO.34

PASAR BARU, SIBOLGA KOTA

YULIANA

M.SIHOTANG DR.

BENNY, DR

- 0631-25006/25007/25008| 0631-25006 Y Y Y ACTIVE ALL [email protected]

om

LIST PROVIDER INDEMNITY MANDIRI INHEALTH (BANK MANDIRI-MAYORA DAN TELADAN ) - 31 JULI 2015-final revise 53 14/08/2015